Cervicogenic headache physical therapy management

Cervicogenic headache physical therapy  management Blog  Headache   The medical term cervicogenic headache refers to a specific kind of a headache, specifically a headache resulting from another issue, in this case, a problem with the neck. Cervicogenic headaches are usually chronic (repeating) in nature resulting from issues in either the soft tissue or the bony structures of the neck. The National Institutes of Health in the United States has published statistics indicating that approximately a quarter of the adult female population suffers from cervicogenic headaches, a rate four times higher than with men. Some of the most common symptoms of a cervicogenic include dizziness, a feeling of lightheadedness, nausea, intermittent problems with vision, and discomfort in the area of the upper rear of the neck where three muscle groups called the suboccipital muscles join the skull. While a number of treatments have been developed to discover what helps a cervicogenic headache, the latest research has only confirmed a few of these as being truly effective. The International Headache Society has classified headaches into 14 different categories, and cervicogenic headaches are considered to be secondary headaches with discomfort arising in the neck and felt in the neck and/or face. Some individuals who suffer from cervicogenic headaches feel the pain on only one side of their head or face while other sufferers experience discomfort in multiple areas. Cervicogenic headaches are believed to be caused by problems in the muscles or bones in the neck, including issues with the joints, ligaments, muscles and other soft tissues. The original issue in the neck may be the result of trauma or it is associated with people who have poor posture or keep their neck unmoving for long periods of time.

How to treat cervicogenic headache

Due to the complexity in identifying the underlying cause of the headache, medical professionals have devised a number of techniques to discover how to treat cervicogenic headache (CGH). These treatments are classified as being either invasive or non-invasive, and the analysis of multiple studies have identified the invasive techniques as being the most effective methods yet discovered. The most common invasive techniques include surgery, injecting medicine into the affected area. Common non-invasive methods being used to treat CGH include applying the electric current through the skin (TENS), massage, chiropractic manipulation, and physical therapy. Currently, there is no broad consensus on the best practice for non-invasive treatments of cervicogenic headaches. The NIH recently commissioned a meta-analysis of published research on the subject of

The NIH recently commissioned a meta-analysis of published research on the subject of treating cervicogenic headaches using physical therapy management techniques. A number of different physical therapy management techniques were assessed, including mobilization combined with exercise, cervical SNAG mobilization, cervical mobilization and manipulation, and cervical and/or upper thoracic manipulation used on its own. More than 105 different published papers on physical therapy management techniques were selected for the meta-review, although the search was eventually narrowed down to just six of the most relevant studies. The six studies of physical therapy management treatment modalities for cervicogenic headaches involved 457 different patients. All six of the studies included analysis of the physical therapy management strategy of using either manipulation or mobilization on individuals who suffer from cervicogenic headaches. Four of the studies concluded that using manipulation had some positive effects but two studies indicated no benefit to using manipulation to treat cervicogenic headaches. One study focused on both children and adults with CGH and whether cervical manipulative therapy was effective but was unable to determine if this type of therapy showed any measurable benefit. One study investigated whether using cervical and upper thoracic manipulation was effective in treating CGH and discovered that this form of treatment demonstrated significant improvements in reducing the intensity of CGH discomfort, the amount of neck pain as well as related symptoms. Another study included in the NIH meta-analysis looked at whether low amplitude, high-velocity cervical manipulation would help reduce pain and related symptoms for CGH sufferers. The study concluded that this technique significantly reduced both the frequency of CGH and how long lasted when they did occur. The same study also measured whether the participants’ levels of using pain relieving medication would drop but discovered no significant decrease. The last study analyzed by NIH measured whether exercise alone could be useful in treating CGH. The results of the study showed that participants who performed exercises showed a significant decrease in the intensity, frequency, and duration of neck pain was reduced by using exercise but that the duration of their headaches stayed about the same. Although the NIH meta-analysis study looked at the most relevant papers published in medical journals about treating cervicogenic headaches, the authors concluded that only a limited amount of conclusions could be drawn due to an insufficient number of relevant studies and techniques assessed. For more information from the National Institutes of Health about cervicogenic headache, click on the link. Our clinic uses all of the advanced techniques described above to treat headaches and migraines.

The six studies of physical therapy management treatment modalities for cervicogenic headaches involved 457 different patients. All six of the studies included analysis of the physical therapy management strategy of using either manipulation or mobilization on individuals who suffer from cervicogenic headaches. Four of the studies concluded that using manipulation had some positive effects but two studies indicated no benefit to using manipulation to treat cervicogenic headaches. One study focused on both children and adults with CGH and whether cervical manipulative therapy was effective but was unable to determine if this type of therapy showed any measurable benefit. One study investigated whether using cervical and upper thoracic manipulation was effective in treating CGH and discovered that this form of treatment demonstrated significant improvements in reducing the intensity of CGH discomfort, the amount of neck pain as well as related symptoms. Another study included in the NIH meta-analysis looked at whether low amplitude, high-velocity cervical manipulation would help reduce pain and related symptoms for CGH sufferers. The study concluded that this technique significantly reduced both the frequency of CGH and how long lasted when they did occur. The same study also measured whether the participants’ levels of using pain relieving medication would drop but discovered no significant decrease. The last study analyzed by NIH measured whether exercise alone could be useful in treating CGH.

The results of the study showed that participants who performed exercises showed a significant decrease in the intensity, frequency, and duration of neck pain was reduced by using exercise but that the duration of their headaches stayed about the same. Although the NIH meta-analysis study looked at the most relevant papers published in medical journals about treating cervicogenic headaches, the authors concluded that only a limited amount of conclusions could be drawn due to an insufficient number of relevant studies and techniques assessed. For more information from the National Institutes of Health about cervicogenic headache, click on the link. Our clinic uses all of the advanced techniques described above to treat headaches and migraines.

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In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)

image

Complete tear of rectus femoris
with large hematoma (blood)

image

Separation of muscle ends due to tear elicited
on dynamic sonography examination

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