Cervicogenic Headache vs. Migraine

Cervicogenic Headache vs. Migraine

 
Cervicogenic headache (CGH) refers to a headache of cervical origin. Historically, these types of headaches were difficult to diagnose and as a result may go misdiagnosed or wrongfully categorized as a migraine. With our growing understanding of these etiologies we can now us subjective and objective information to improve our differential diagnoses.

Subjective presentation: 
  1. Hx of pain in head projected into neck usually one side > then other side.
  2. Symptoms have a cause and effect relationship with poor posture or sustained head positions.
Objective presentation: 
  1. Lateral glides for stiffness particularly in C1-3.
  2. Upper cervical rotation average < 20 degrees either side as noted with Cervical Flexion Rotation Test (CFR). (See how to perform CFR testing below)
  3. Migraine with aura and asymptomatic individuals with average 39 degrees using CFR.
  4. Reproduction of CGH with ischemic pressure. (See trigger point chart below as reference)
Cervical Flexion-Rotation Test

The patient is supine and the examiner flexes the cervical spine FULLY in order to block rotational movement below the atlanto-axial articulation. Passively rotate the head left and right, determining range of motion (ROM) and end-feel. A firm end-feel with limited ROM presumes limited rotation of the atlas on the axis.

Common Trigger points related to CGH

References

Phil Page, PhD, PT, ATC, CSCS, FACSM, CERVICOGENIC HEADACHES: AN EVIDENCE-LED APPROACH TO CLINICAL MANAGEMENT, Int J Sports Phys Ther. 2011 Sep; 6(3): 254–266.

Sjaastad O, Fredriksen TA, Pfaffenrath V. Cervicogenic headache: Diagnostic criteria. Headache.1990;30:725–726.