That reproduction of headache when examining upper cervical segments confirms cervicogenic relevancy – wrong!
Whilst reproduction of typical symptoms does not confirm relevancy, if this occurs, one can be very, very, suspicious of cervical involvement.
However, there are situations in which reproduction is possible and the source is not the upper cervical segments, for e.g., lack of inhibition because of insufficient serotonin or dysfunction of descending inhibitory pathways (Diffuse Noxious Inhibitory Controls – DNICs), or sensitisation from noxious trigeminal afferents.
As the headache producing (cervical) technique is sustained in the presence of the abovementioned situations the referred pain does not change because the intervention is ‘spinal’. However resolution of referred symptoms as the examination technique is sustained confirms cervical afferents as the source, symptoms are responding to a spinal intervention i.e. Reproduction and Resolution confirms Relevancy.
Recent ground breaking research has shown that Reproduction and Resolution of referred head pain, which is unique and fundamental to the Watson Headache® Approach, De-sensitises the brainstem.24
The Watson Headache® Approach is the only manual cervical approach which has been shown to affect the very essence of the headache-migraine process, thus confirming cervicogenic relevancy.
References:
Kaube H, Katasavara Z, Przywara S, Drepper J, Ellrich J, Diener HC. Acute migraine headache. Possible sensitization of neurons in the spinal trigeminal nucleus? Neurology 2002; 58:1234-1238
Katsavara Z, Lehnerdt G, Duda B, Ellrich J, Diener HC, Kaube H. Sensitization of trigeminal nociception specific for migraine but not pain of sinusitis. Neurology 2002; 59:1450-1453
Katsavara Z, Giffin N, Diener HC, Kaube H. Abnormal habituation of ‘nociceptive’ blink reflex in migraine – evidence for increased excitability of trigeminal nociception. Cephalalgia 2003; 23:814-819
Sandrini G, Cecchini AB, Milanov I, Tassorelli C, Buzzi MG, Nappi G. Electrophysiological evidence for trigeminal neuron sensitisation in patients with migraine. Neurosci Lett 2002; 317:135-138
Nardone R, Ausserer H, Bratti A, Covi M, Lochner P, Marth R, Florio I, Tezzon F. Trigemino-Cervical Reflex Abnormalities in Patients with Migraine and Cluster Headache. Headache 2008; 48(4):578-585
Nardone R, Tezzon F. The trigemino-cervical reflex in tension-type headache. European Journal of Neurology 2003; 10(3):307-312
Varlibas A, Erdemoglu Ak. Altered trigeminal system excitability in menstrual migraine patients. The Journal of Headache and Pain 2009; 10(4):277-282
Watson DH, Drummond PD. Head Pain Referral During Examination of the Neck in Migraine and Tension-Type Headache. Headache 2014;54:1035-1045
Rothbart P. The cervicogenic headache: A pain in the neck. Can J Diagnos 1996; 13: 64–71.
Takmaz AS, Inan N, Ucler S, Yazar MA, Inan L, Basar H. Greater occipital nerve block in migraine headache: Preliminary results of 10 patients. 2008 Jan;20(1):47-50
Yi X et al Cervicogenic headache in patients with presumed migraine missed diagnosis or misdiagnosis? J Pain. 2005 Oct;6(10):700-3
Young WB, Marmura M, Ashkenazi A, Evans RW. Expert opinion: Greater occipital nerve and other anesthetic injections for primary headache disorders. 2008;48:1122-1125
Rozen T. Cessation of hemiplegic migraine auras with greater occipital nerve blockade. Headache 2007;47:917-928
Peres MF, Stiles MA, Siow HC. Greater occipital nerve blockade for cluster headache. Cephalalgia 2002;22:520-522
Porta-Etessam J, Cuadrado ML, Galán L, Sampedro A, Valencia C. Temporal response to bupivacaine bilateral great occipital block in a patient with SUNCT syndrome. J Headache Pain 2010 Apr;11(2):179
Tobin J,Stephen Flitman S. Nerve Blocks: When and What to Inject? Headache 2009;49(10):1479-85
Pascual J. Treatment of hemicrania continua by occipital nerve stimulation with a bion device. Curr Pain Headache Rep 2009 Feb;13(1):3-4
Burns B, Watkins L, Goadsby PJ. Treatment of hemicrania continua by occipital nerve stimulation with a bion device: Long term follow-up of a crossover study. Lancet Neurol 2008;7:1001-1012
de Tommaso M, Guido M, Libro G, Sciruicchio V, Puca F. Zolmitriptan reverses blink reflex changes induced during the migraine attack in humans. Neurosci Lett 2000 Jul 28;289(1):57-60
Hoskin KL, Kaube H, Goadsby PJ. Sumatriptan can inhibit trigeminal afferents by an exclusively neural mechanism. Brain1996; 119:1419-28
Kaube H, Katasavara Z, Przywara S, Drepper J, Ellrich J, Diener HC. Acute migraine headache. Possible sensitization of neurons in the spinal trigeminal nucleus? Neurology 2002; 58:1234-1238
Watson DH, Drummond PD Cervical Referral of Head Pain in Migraineurs: Effects on the Nociceptive Blink Reflex. Headache 2014;54:1035-1045
Rozen TD, Haynes GV, Saper JR, Sheftell FD. Abrupt onset and termination of cutaneous allodynia (central sensitization) during attacks of SUNCT. Headache 2005;45:153-155
Cooper G, Bailey B, Bogduk N. Cervical zygapophysial joint pain maps. Pain Med 2007;8:344-353
Sjaastad O, Fredriksen TA, Pfaffenrath V. Cervicogenic headache: diagnostic criteria. Headache1998; 38: 442–5.!
Headache Classification Subcommittee of the International Headache Society.The International Classification of Headache Disorders, 2nd edn. Cephalalgia 2004; 24 (Suppl. 1): 1–151.!
Porter RW, Miller CG. Back pain and trunk list. Spine. 1986;11:596–600.
McKenzie RA, May S. Mechanical Diagnosis and Therapy: The Lumbar Spine. 2nd ed. Waikanae, NZ: Spinal Publications; 2003.
Suk KS, Lee HM, Moon SH, Kim NH. Lumbosacral scoliotic list by lumbar disc herniation. Spine. 2001;26: 667–671.
Mercer S, Bogduk N. The ligaments and anulus fibrosus of human adult cervical intervertebral discs. Spine 1999;24: 619–626!
Mercer SR, Jull GA. Review: morphology of the cervical intervertebral disc: implications for McKenzie’s model of the disc derangement syndrome. Manual Therapy 1996; 2: 76–81
Pfaffenrath V, Dandekar R, Mayer ETh, Hermann G, Pöllmann W. Cervicogenic Headache: Results of Computer-Based Measurements of Cervical Spine Mobility in 15 Patients Cephalalgia, March 1988; vol. 8, 1: pp. 45-48.
Sizer PS, Phelps V, Azevedo E, Haye A, Vaught M. Diagnosis and Management of Cervicogenic Headache. Pain Pract 2005 Sep;5(3):255-74.
Until next time
Dr Dean H Watson PhD Musculoskeletal Physiotherapist
MAppSc(Res) GradDipAdvManipTher(Hons) DipTechPhty
If you are new to Watson Headache®, welcome to the Watson Headache® Approach, an evidence-informed practice when considering the role of the neck in Cervicogenic and Primary Headache.
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Misconception 6 of 10
Examining Upper Cervical Segments
That reproduction of headache when examining upper cervical segments confirms cervicogenic relevancy – wrong!
Whilst reproduction of typical symptoms does not confirm relevancy, if this occurs, one can be very, very, suspicious of cervical involvement.
However, there are situations in which reproduction is possible and the source is not the upper cervical segments, for e.g., lack of inhibition because of insufficient serotonin or dysfunction of descending inhibitory pathways (Diffuse Noxious Inhibitory Controls – DNICs), or sensitisation from noxious trigeminal afferents.
As the headache producing (cervical) technique is sustained in the presence of the abovementioned situations the referred pain does not change because the intervention is ‘spinal’. However resolution of referred symptoms as the examination technique is sustained confirms cervical afferents as the source, symptoms are responding to a spinal intervention i.e. Reproduction and Resolution confirms Relevancy.
Recent ground breaking research has shown that Reproduction and Resolution of referred head pain, which is unique and fundamental to the Watson Headache® Approach, De-sensitises the brainstem.24
The Watson Headache® Approach is the only manual cervical approach which has been shown to affect the very essence of the headache-migraine process, thus confirming cervicogenic relevancy.
References:
Until next time
If you are new to Watson Headache®, welcome to the Watson Headache® Approach, an evidence-informed practice when considering the role of the neck in Cervicogenic and Primary Headache.
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