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Cervical Spine Dysfunction. CRANIOFACIAL PAIN OF CERVICAL ORIGIN Recognize craniofacial pain of cervical origin Understand basic anatomy and physiology of the upper cervical spine Overview of craniovertebral testing and treatment. Occipital/supraorbital syndrome (C1).

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    • Recognize craniofacial pain of cervical origin
    • Understand basic anatomy and physiology of the upper cervical spine
    • Overview of craniovertebral testing and treatment

Occipital/supraorbital syndrome (C1)

OA unilateral lesion, unilateral pain, retroorbital nausea


Arnold’s neuralgia - Greater Occipital Nerve Impingement (C2)

Unilateral Pain from posterior rami C2, sharp shooting attacks of pain, pain at posterior neck to vertex, pain at retromastoid region


Otic Syndrome- Ventral Rami C2-lesser occipital nerve and greater auricular nerve

Pain, buzzing, vertigo symptoms related to ears without ear pathology


Auriculomandibular Neuralgia - C3

Pain corresponds to C3, occipital headache, pain radiating to auricular lobe and angle of mandible, generally unilateral


Facet Joint Referred Pain Patterns

C2 - C3 and C3 - C4 refer pain into head


The cervical spine connection

Trigeminal system and C1-C3 nerves along with CN VII, IX,X

Pain fibers descending from the brain stem converge in the posterior horn of the upper cervical spine. This convergence gives an anatomical basis for pain referral from the neck to the head.


A Single Combined Nucleus-Trigeminocervical Nucleus

“terminals of the trigeminal nerve and the upper three cervical nerves ramify in a continuous column of grey matter formed by the par caudalis of the spinal nucleus of the trigeminal nerve and dorsal horns of the upper three cervical segments”

Bogduk, 1995

Kraus, 1988


Transmits PAIN

Nociceptive information from cervical spine tissues is transmitted to the trigeminocervical nucleus, which in turn gives the patient the perception of symptoms in the head, face and jaw area.


Cervicogenic Headache

  • pain sensitive structures in the neck
  • pathological processes or physiologic dysfunctions within the neck
  • ipsilateral pain and stiffness
  • decreased cervical ROM
  • tenderness at cervical facets
  • pain elicited with active or passive exam of the neck
suboccipital triangle
Suboccipital Triangle
  • Superior Oblique – occiput to TP C1
  • Inferior Oblique – TP C1 to C2
  • Rectus Capitus Post Major – occiput to

spinous process C2

greater occipital nerve
Greater Occipital Nerve
  • Between C1 and C2
  • Emerges under inferior oblique
  • At semispinalis
  • At upper trapezius
the axis
The Axis
  • Pacifier shaped
  • Convex shoulder of axis are built to allow rotation
oa testing
OA Testing
  • Occipital / Atlas Testing (OA)
  • Imbalance of the occiput as it meets the first vertebrae (C1) can create head and facial pani.
  • Testing and treatment to the occiput(O) and atlas (A) complex can help eliminate pain.
physical therapy
  • MANUAL THERAPY – to correct the upper cervical alignment and restore normal biomechanics of the upper cervical spine and restore the normal lordosis or arch to the neck
  • Neuromuscular Reeducation Exercise to balance the craniocervical, craniomandibular, and the scapulothoracic systems.
  • Mechanical Home Cervical Traction Set Up
live life at ease
“Live life at ease.”
  • Call 216-682-0413for your comprehensive craniomandibular cervical evaluation and treatment.