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Headache Tree

Red Flags: Worst HA of life, wake up at night, altered/LOC Dizziness. Refer to MD/ER. No. Refer to Vestibular Sheet . Laterality of Sx ?. Unilateral (or U on both sides). Palpation: Sx may occur ipsilaterally or shift to contralateral side. Headache Tree.

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Headache Tree

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  1. Red Flags: Worst HA of life, wake up at night, altered/LOC Dizziness Refer to MD/ER No Refer to Vestibular Sheet Laterality of Sx? Unilateral (or U on both sides) Palpation: Sx may occur ipsilaterally or shift to contralateral side Headache Tree Bilateral(sx reproduced B at the same time) Palpation: sx occur ipsilaterally Migraine HATx: Pharmacological Tension HA Tx: Pharmacological Multiple, but not neck motion Multiple, but not neck motion Triggers? Neck Motion, Valsalva, Pressure over C1-C3 Alcohol, Occurs at predictable times/day None Hemicrania Continua HA Tx: Pharmacological Cervicogenic HATx: PT (jt mobs/manips, stretching, STM, strengthening, postural/NM re-education, TENS, biofeedback) and/or Pharmacological Cluster HATx: Pharmacological Adapted from Biondi (2005)

  2. Differential Dx for Headaches Biondi (2005)

  3. Cervicogenic Treatment Tree Limited ROM:Tx: Self stretches, PROM Soft Tissue Assessment:  Muscle Tension or TrP (UT, levatorscap, suboccipitals, SCM, scalenes, paraspinals) Tx: STM, ischemic compression/suboccipital release, stretching, e-stim Joint Mobility Assessment: Central/U PAs cervical and thoracic, downglides, OA, AA* Tx: manips (per thoracic CPR or qualified cervical therapist), mobs*Test with Cervical Flexion Rotation Test (Hall 2010) and HEP of self rotation SNAGS (Hall 2007) Strength/Endurance Assessment: Deep cervical flexors, scapular stabilizersTx: strengthening/endurance TEs, NM re-ed** ** Test with Craniocervical Flexion Test (Harris et al 2005) and possible tx of low load cervical motor control TEs (Jull 2002) • Postural Assessment: • Forward head, rounded shoulders, or of thoracic kyphosis or cervical lordosisTx: postural/NM re-ed, biofeedback, pt education/ • ergonomics Further Pain Management:- Pt education for fear avoidance - Refer out for pharmacological/injection/behavior tx - Possible surgical intervention If Any Radicular Like Symptoms: Assess for Radiculopathy CPR, nerve tension tests, and/or TrP (ie: SCM, scalenes)

  4. Cervicogenic Headache Diagnosis Hadelman et al (2001)

  5. References Antonaci, Fabio, Torbjorn A. Fredriksen, and OttarSjaastad. "Cervicogenic Headache: Clinical Presentation, Diagnostic Criteria, and Differential Diagnosis." Current Pain and Headache Reports 5. (2001): 387-392. 11 Nov 2010. Biondi, David M. "Cervicogenic Headache: Diagnostic Evaluation and Treatment Strategies." Current Pain and Headache Reports 5. (2001): 361-368. 11 Nov 2010. Biondi, David M. "Cervicogenic Headache: A Review of Diagnostic and Treatment Strategies." Journal of the American Osteopathic Association 105.4 (2005): S16-S22. 11 Nov 2010. Biondi, David M. "Cervicogenic Headache: Mechanisms, Evaluation, and Treatment Strategies." Journal of the American Osteopathic Association 100.9 (2000): S7-S14. 11 Nov 2010. Child’s, Cleland, Elliot, Teyhen, Wainner, Whitman, Sopky, Godges, Flynn. “Neck Pain: Clinical Practice Guidelines linked to the International Classification of Functioning, Disability, and Health From the Orthopaedic Section of the American Physical Therapy Association.” J Orthop Sports Phys Ther 2008; 38(9):A1-A34. Falla, D. "Unraveling the Complexity of Muscle Impairment in Chronic Neck Pain." Manual Therapy 9. (2004): 125-133. 28 Nov 2010. Fernandez-De-Las-Penas, Cesar, Marta Perez-De-Heredia, Alberto Molero-Sanchez, and Juan Carlos Miangolarra-Page. "Performance of the Craniocervical Flexion Test, Forward Head Posture, and Headache Clinical Parameters in Patients with Chronic Tension-Type Headache: A Pilot Study." Journal of Orthopedic and Sports Physical Therapy 37.2 (2007): 33-39. 11 Nov 2010. Fernandez-De-Las-Penas, Cesar, Cristina Alonso-Blanco, Jesus San-Roman, and Juan Carlos Miangolarra-Page. "Methodological Quality of Randomized Controlled Trials of Spinal Manipulation and Mobilization in Tension-Type Headache, Migraine, and Cervicogenic Headache." Journal of Orthopedic and Sports Physical Therapy 36.3 (2006): 160-169. 11 Nov 2010. Haldeman, Scott, and Simon Dagenais. "Cervicogenic Headaches: a critical review." Spine Journal 1. (2001): 31-46. 11 Nov 2010. Haldeman, Scott, and Simon Dagenais. "Choosing a treatment for cervicogenic headache: when? what? how much?.” Spine Journal 10. (2010): 169-171. 11 Nov 2010. Hall, Toby, Kathy Briffa, Diana Hopper, and Kim Robinson. "Long-Term Stability and Minimal Detectable Change of the Cervical Flexion-Rotation Test." Journal of Orthopedic and Sports Physical Therapy 40.4 (2010): 225-229. 11 Nov 2010. Hall, Toby et al. "Efficacy of a C1-C2 Self-sustained Natural ApophysealGLide (SNAG) in the Management of Cervicogenic Headache." Journal of Orthopedic and Sports Physical Therapy 37.3 (2007): 100-107. 11 Nov 2010. Harris, Kevin D. "Reliability of a Measurement of Neck Flexor Muscle Endurance." Physical Therapy 85.12 (2005): 1349-1355. 28 Nov 2010. Jull, Gwendolen et al. "A Randomized Controlled Trial of Exercise and Manipulative Therapy for Cervicogenic Headache." Spine 27.17 (2002): 1835-1843. 27 Nov 2010. McDonnell, Mary Kate, Shirley A Sahmann, and Linda Van Dillen. "A Specific Exercise Program and Modification of Postural Alignment for Treatment of Cervicogenic Headache: A Case Report." Journal of Orthopedic and Sports Physical Therapy 35.1 (2005): 3-15. 11 Nov 2010.

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