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AI-Generated response:

How do you diagnose a cervicogenic headache

Answer generated on June 4, 2024

The AI-generated responses are for illustration purposes only and should not be used for medical purposes.

To diagnose a cervicogenic headache, perform a thorough physical examination focusing on the head and neck, assess the patient's headache history, and consider diagnostic imaging and nerve blocks if necessary.

  • Cervicogenic headache often presents as unilateral or bilateral headache associated with neck movement and reduced neck mobility; diagnosis is supported if the headache responds to treatments targeting the cervical spine.[1]

  • Physical examination should include checking for tenderness in the cervical paraspinal and trapezius muscles, which is indicative of cervicogenic headache.[1]

  • MRI of the cervical spine without contrast should be considered if cervicogenic headache is suspected, especially to rule out other causes.[1]

  • Diagnostic nerve blocks, such as occipital nerve blocks, can be both diagnostic and therapeutic for cervicogenic headache.[1]

  • The cervical flexion-rotation test (CFRT) has shown moderate diagnostic accuracy in differentiating cervicogenic headache from other types of headache.[2]

Additional info

When diagnosing cervicogenic headache, it's crucial to differentiate it from other headache types such as migraines or tension-type headaches, which can present with overlapping symptoms. The response to specific treatments targeting the cervical spine can be a key indicator in confirming the diagnosis. Imaging studies like MRI are particularly useful when the clinical presentation is ambiguous or when there is a lack of response to initial conservative treatments. Additionally, nerve blocks can provide both diagnostic clarity and symptomatic relief, which is particularly useful in a clinical setting where immediate patient response can guide further management strategies. The use of the cervical flexion-rotation test can further aid in the diagnosis by providing a specific physical examination tool with a good balance of sensitivity and specificity.

References

Reference 1

1.

Elsevier ClinicalKey Clinical Overview

Diagnosis Cervicogenic headache presents as a unilateral or bilateral headache, is associated with reduced range of motion of the neck, and is exacerbated by neck movement. Response to treatments targeting the primary cervical spine disease helps confirm the diagnosis Giant cell arteritis is a systemic vasculitis that commonly involves cranial arteries. New-onset progressive headache with jaw claudication and a history of polymyalgia rheumatica should raise suspicion for arteritis. Elevated erythrocyte sedimentation rate and inflammation of the arterial wall on the temporal artery biopsy are the tests used to confirm the diagnosis

Workup Vital signs can show evidence for infectious etiology and hypertension. Obesity or notable weight gain should prompt the consideration of idiopathic intracranial hypertension Perform a thorough examination of the head and neck areas, noting tenderness in response to pressure along the temporal arteries (giant cell arteritis) and occipital nerves (occipital neuralgia). Check cervical paraspinal and trapezius muscles for focal tenderness (cervicogenic headache) Evaluate meningeal signs Kernig sign: while in a supine position, hip and knee are flexed to 90° and knee is slowly extended. The appearance of resistance or pain during extension of the patient’s knees beyond 135° constitutes a positive Kernig sign Brudzinski sign: with 1 hand behind the patient’s head and the other on chest, passively flexing the neck causes reflex flexion of the patient’s hips and knees. This constitutes a positive Brudzinski sign The fundoscopic examination is a very important part of the examination for evaluation of headache disorders Signs of papilledema may signal high intracranial pressure. Spontaneous venous pulsations confirm the absence of high intracranial pressure Conduct a neurologic examination, including cranial nerve, motor reflexes, and sensory and cerebellar examinations

Workup Side locked headache, trigeminal autonomic cephalalgias, hypnic headache, and new daily persistent headache (especially in older adults) should be evaluated with MRI of the brain with and without contrast. For trigeminal autonomic cephalalgias, vascular imaging (either magnetic resonance angiography of head and neck or CT angiography) should be added to the workup In patients presenting with early morning headaches resolving in less than 4 hours, sleep apnea might be the underlying cause, so a sleep study should be added to the workup MRI of the cervical spine without contrast is added to the imaging when cervicogenic headache is suspected

Treatment Procedures for chronic headache syndromes include: OnabotulinumtoxinA injections Occipital nerve blocks Trigger point injections Sphenopalatine ganglion block OnabotulinumtoxinA injections are approved by the FDA for chronic migraine and have effectively been used for intractable chronic migraine Occipital nerve blocks and trigger point injections can help for the diagnosis and the treatment of cervicogenic headache. If the level of cervical spine disease is moderate to severe or pain does not respond to occipital nerve blocks and trigger point injections, then a pain management specialist, orthopedic physician, and neurosurgeon should be consulted

Reference 2

2.

Demont A, Lafrance S, Benaissa L, Mawet J. Cervicogenic Headache, an Easy Diagnosis? A Systematic Review and Meta-Analysis of Diagnostic Studies. Musculoskeletal Science & Practice. 2022;62:102640. doi:10.1016/j.msksp.2022.102640.

Publish date: December 4, 2022.

BACKGROUND: The diagnosis of cervicogenic headache (CGH) remains a challenge for clinicians as the diagnostic value of detailed history and clinical findings remains unclear. OBJECTIVES: To update and evaluate available evidence of the prevalence and the diagnostic accuracy of the detailed history and clinical findings for CGH in adults with headache. DESIGN: Systematic review with meta-analysis. METHODS: CINAHL, Cochrane Central, Embase, PEDro and PubMed were searched for studies before March 2022 that reported detailed history and/or clinical findings related to the diagnosis of cervicogenic headache. Study selection, risk of bias assessment (QUADAS-2 and PROBAST), and data extraction were performed. Meta-analyses for the cervical flexion-rotation test (CFRT) was performed. Certainty of the evidence was assessed with the GRADE approach. RESULTS: Eleven studies were included. Moderate certainty evidence indicated that the CFRT differentiated CGH from lower cervical facet-induced headache, migraine, concomitant headaches or asymptomatic subjects (Se 83.0% [95%CI:70.0%-92.0%]; Sp 83.0% [95%CI:71.0%-91.0%]; positive LR 5.0 [95%CI:2.6-9.5]; negative LR 0.2 [95%CI:0.1-0.4]; n = 4 studies; n = 182 participants). Several diagnostic classifications and test clusters based on headache history and clinical findings can be useful, despite uncertain accuracy, in formulating the diagnosis of CGH. CONCLUSION: Evidence support to undertake an evaluation of headache history and signs and symptoms and a physical examination of the patient neck to diagnose CGH.

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