Effects of different methods of physiotherapy in individuals with cervicogenic headaches

Objective. To assess the effects of different physiotherapy methods in individuals with cervicogenic headache. Methods. 20 subjects with cervicogenic headaches have been studied. Subjects were randomized to two groups of 10 subjects. The first group of subjects underwent physiotherapy with post – isometric relaxation, the second group – physiotherapy in combination with vibration. Before and after the interventions, pain intensity, neck disability index, active cervical range of motion and neck muscle strength were evaluated in all subjects. Results. Physiotherapy reduces the intensity of pain (from strong and very strong to moderate intensity), improves neck function (from severe to moderate disability), increases active cervical range of motion by four to six degrees and increases neck muscle strength (p < 0,05). When comparing results between groups, no statistically significant difference in results were observed (p > 0,05). Conclusion: Complex physiotherapy in combination with post – isometric relaxation or vibration helps to improve the function of individual neck, increase active cervical range of motion and strength of muscle strength.

A comparative shape analysis of the cervical spine between individuals with cervicogenic headaches and asymptomatic controls

As some researchers theorized that cervicogenic headache (CEH) might be related to bony and discal features of the cervical spine, this retrospective study examined the shapes of the cervical vertebrae and intervertebral discs (IVDs) of individuals with CEH and compared them to asymptomatic controls. Scans of 40 subjects in their late 20’s–mid 30’s affected with CEH and 40 asymptomatic controls were obtained (overall = 19,040 measurements, age-sex matched, 20 males and 20 females in each group). The following cervical spine variables were measured: Supine lordosis, vertebral body-heights, A-P lengths, mediolateral widths and sagittal-wedging; IVDs heights and sagittal-wedging; pedicle heights, widths and transverse angles; laminar widths and transverse angles; articular facet angles, spinal canal, and transverse foramen lengths, widths, and areas. Both groups had similar shape variation along the cervical in all the measured parameters. There were no significant left–right differences in all measured parameters and no significant differences between the CEH and control groups concerning sex and age. Cervical IVDs were lordotic in shape, whereas their adjacent vertebral bodies were kyphotic in shape except for C2. In conclusion, the shape of the cervical spine and IVDs in subjects in their late 20’s–mid 30’s affected with CEH is identical to asymptomatic controls.

The benefits of manual therapy and active cervical exercises in pacients with cerviogenic headache

Introduction: Cervicogenic headache stems from a dysfunctional mechanism that frequently affects the upper region of the cervical spine, often involving multiple tissues connected with the occipital, submandibular, and orofacial region. Objectives: The main objective of this study is to demonstrate the therapeutic effectiveness of a personalized program of manual therapy and specific exercises in patients with cervicogenic headaches. Material and Methods: The study included 44 patients. Specific functional tests of the cranio-cervical-mandibular complex, namely the evaluation of the cranio-cervical-mandibular complex (according to Rocabado), cervical flexion-rotation test, cervical flexor endurance test, cervical extensors endurance test, and palpation of trigger points and cervical spine dynamics, were employed. Results: The analysis of demographic data shows a significantly increased prevalence of headache among women. The symptomatology that almost always accompanies episodes of cervicogenic headache is localized neck pain. The intensity and frequency of the symptoms are strongly associated with alterations in the dynamics of the upper cervical spine and chronic sleep disorders. Conclusion: Cranio-cervical manual therapy has proven effective in patients with cervicogenic headaches. The implementation of a strategy based on manual therapy and active exercise had a superior statistical and clinical result compared to the exclusively manual therapeutic approach.

Effectiveness of Exercise and Manual Therapy as Treatment for Patients with Migraine, Tension-Type Headache or Cervicogenic Headache: An Umbrella and Mapping Review with Meta-Meta-Analysis

The aim of the study was to perform a mapping and umbrella review with meta-meta-analysis (MMA) to synthesise and critically evaluate the effectiveness of manual therapy (MT) and aerobic exercise (AE) in relation to pain intensity, frequency, disability and quality of life in patients with migraines, tension-type headaches (TTH) and cervicogenic headaches (CGH). A systematic search was conducted in PubMed, PEDro, Scielo and Google Scholar up to December 2020. A total of 18 articles met the inclusion criteria, and only 8 were included in the quantitative analysis. The MMA showed results in favour of the interventions in terms of pain intensity and quality of life in migraine, TTH and CCH. Data were also in favour of the intervention in terms of pain frequency in migraine and in terms of disability in TTH. However, there were no significant effects on pain frequency in TTH and CGH. The results showed moderate evidence to suggest that AE reduces pain intensity in patients with migraine. In addition, the evidence in favour of MT or a mixed intervention (including therapeutic exercise) was also moderate in terms of reducing pain intensity in patients with TTH.

EFFECTS OF TRIGGER POINT DRY NEEDLING ON NECK PAIN AND CERVICAL RANGE OF MOTION (ROM) IN PATIENTS WITH CERVICOGENIC HEADACHE: A CASE SERIES

Musculoskeletal headaches are a common complaint with impaired postures. About 15% to 20% of chronic and recurrent headaches are diagnosed as cervicogenic headaches and are related to musculoskeletal impairments (4). Often associated with tension in posterior cervical muscles and pain at the attachment of the cervical extensors, at the cervico-thoracic junction, and/or radiating across the top, side, or back of the scalp

Cervicogenic Headache Hypothesis and Anterior Cervical Decompression as a Treatment Paradigm

Cervicogenic headaches are a controversial clinical entity that affect many patients suffering from cervical spondylosis. Understanding the pathogenesis and identifying the nociceptive sources of cervicogenic headaches is critical to properly treat these headaches. A multimodal approach is necessary to treat these headaches using a variety of medical tools. Surgical interventions are reserved for patients that fail maximal medical therapy. The anterior cervical spine surgery has shown promise in the treatment of cervicogenic headaches and this success has hinted at a ventral source of nociceptive pathology. Continued research and development are required to improve outcomes in patients suffering from cervicogenic headaches.

Does Cervicogenic Headache Result in the Presence of Neural Tension, and Does this Affect the Position and Mobility of Atlas?

Background: Cervicogenic headaches (CGH) can be the result of dysfunction of the upper cervical spine. Due to the soft tissue connection between muscle, cervical fascia, and dura, this region might contribute to the development of CGH. Objective: Evaluate if subjects with CGH have neural tension signs. The secondary objective was to investigate if a correlation between the position and mobility of atlas and cervicogenic headaches exists. Methods: 60 Subjects were recruited. Self-reported outcome measures, passive neck flexion rotation test, upper limb tension test (ULTT), slump test, and straight leg raise test (SLR) were assessed. Results: There was a significant difference in atlanto-axial rotation to the right with p=0.025. There was no statistical significance in left rotation. There was no significant relationship between CGH, ULTT, slump and SLR with P>0.05. Atlas position was significantly related to CGH with P<0.001, and position of the atlas was significantly related to atlanto-axial motion with p<0.001. Discussion: There is a direct relationship between the position and mobility of atlas and CGH. Fascial connections between structures could result in dural tension and should be considered when managing patients with CGH. The use of the ULTT, Slump test, and SLR test does not appear to be beneficial in identifying those with CGH.

Fluoroscopy-Guided Blockade of the Greater Occipital Nerve in Cadavers: A Comparison of Spread and Nerve Involvement for Different Injectate Volumes

Background. Fluoroscopy-guided blockade of the greater occipital nerve (GON) is an accepted method for treating the symptoms of cervicogenic headaches (CGHs). However, the spread patterns among different injectate volumes of fluoroscopy-guided GON blocks are not well defined. Objective. A cadaveric study was established to determine the spread patterns of different volumes of dye injectate within a fluoroscopic GON block. Study Design. Cadaveric study. Setting. Xingtai Institute of Orthopaedics; Orthopaedic Hospital of Xingtai. Methods. 15 formalin-fixed cadavers with intact cervical spines were randomized in a 1 : 1 : 1 ratio to receive a fluoroscopy-guided GON injection of a 2, 3.5, or 5 ml volume of methylene blue. The suboccipital regions were dissected to investigate nerve involvement. Results. The suboccipital triangle regions, including the suboccipital nerves and GONs, were deeply stained in all cadavers. The third occipital nerve (TON) was stained in 7 of 10 administered 2 ml injections and in all the 3.5 ml and 5 ml injections. Compared to the 3 ml injectate group, the 5 mL cohort consistently saw injectate spreading to both superficial and distant muscles. Limitations. Given that cadavers were used in this study, cadaveric soft tissue composition and architecture can potentially become distorted and consequently affect injectate diffusion. Conclusions. A 3.5 or 5 mL fluoroscopy-guided GON injection of methylene blue successfully stains the GON, TON, and suboccipital nerves. This suggests that such an injection would generate blockade of all three nerve groups, which may contribute to the efficacy of the block for CGH. A volume of 3.5 ml may be enough for the performance of a fluoroscopy-guided GON block for therapeutic purposes.