Cervicocephalic syndrome: Difference between revisions
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== Definition/Description == | == Definition/Description == | ||
A cervicocephalic syndrome is a cervical syndrome associated with deep or superficial pain in the head, dizziness and often visual (nystagmus for example) or auditory disturbances such as tinnitus or dysphagia. The syndrome results in pain and restriction of motion of the upper cervical spine. Cervicocephalic syndrome is therefore different from [[ | A cervicocephalic syndrome is a cervical syndrome associated with deep or superficial pain in the head, dizziness and often visual (nystagmus for example) or auditory disturbances such as tinnitus or dysphagia. The syndrome results in pain and restriction of motion of the upper cervical spine. Cervicocephalic syndrome is therefore different from [[Cervicogenic Headache|cervicogenic headache]]<ref name="Krämer">Krämer J. Intervertebral Disk Diseases: Causes, Diagnosis, Treatment and Prophylaxis. Stuttgart(2006): Thieme. Grades of recomandation B: (book with references of level 1, 2 and 3)</ref>. | ||
== Clinically Relevant Anatomy == | == Clinically Relevant Anatomy == | ||
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== Epidemiology /Etiology == | == Epidemiology /Etiology == | ||
Impingement on the vertebral artery and the sympathetic nerve near the cervical spine can be related to induces cervicocephalic syndrome. By stimulation of nociceptors in zygapophyseal joints, approximate muscles and tendons the symptoms can be stimulated. The irritations can possibly be caused by malpositioned joints at the head/neck junction, deviations of the cervical spine from the body axis, displacement of vertebrae and constriction of the vertebral artery<ref name="Revel">Revel M, Minguet M, Gregoy P, Vaillant J, Mannuel JL. Changes in cervicocephalic kinesthesia after a proprioceptive rehabilitation program in patients with neck pain: a randomized controlled study. Arch Phys Med Rehabil. 1994 Aug;75(8):895-9. Evidence level: 1B (RCT)</ref>. | Impingement on the vertebral artery and the sympathetic nerve near the cervical spine can be related to induces cervicocephalic syndrome. By stimulation of nociceptors in zygapophyseal joints, approximate muscles and tendons the symptoms can be stimulated. The irritations can possibly be caused by malpositioned joints at the head/neck junction, deviations of the cervical spine from the body axis, displacement of vertebrae and constriction of the vertebral artery<ref name="Revel">Revel M, Minguet M, Gregoy P, Vaillant J, Mannuel JL. Changes in cervicocephalic kinesthesia after a proprioceptive rehabilitation program in patients with neck pain: a randomized controlled study. Arch Phys Med Rehabil. 1994 Aug;75(8):895-9. Evidence level: 1B (RCT)</ref>. | ||
== Characteristics/Clinical Presentation == | == Characteristics/Clinical Presentation == | ||
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== Medical Management <br> == | == Medical Management <br> == | ||
=== Medication === | === Medication === | ||
As the problem is situated on a biomechanical level. The roll of mediation in purely symptomatic. No evidence is found for influence of the drugs on the volume or consistency of the cervical discs. Despite this fact medication has been proven to be effective because it relieves the patient of his deep and severe pain. Also Sedatives and tranquillizers can be used. Those can lessen the central sensitization of the biomechanical stress. They can also help relieving the night pain which prevents the patient from having not only physical but also emotional stress. The therapy benefits from these results. Important is that medication is only used as an asset to the physical therapy. It’s important that the patient is well informed and has a say in the therapy as misuse of these drugs is very dangerous<ref>Nilsson N. The prevalence of cervicogenic headache in a random population sample of 20–59-year olds. Spine 1995; 20: 1884–1888. Evidence level: 2C (outcomes research)</ref>.<br>Local injections | As the problem is situated on a biomechanical level. The roll of mediation in purely symptomatic. No evidence is found for influence of the drugs on the volume or consistency of the cervical discs. Despite this fact medication has been proven to be effective because it relieves the patient of his deep and severe pain. Also Sedatives and tranquillizers can be used. Those can lessen the central sensitization of the biomechanical stress. They can also help relieving the night pain which prevents the patient from having not only physical but also emotional stress. The therapy benefits from these results. Important is that medication is only used as an asset to the physical therapy. It’s important that the patient is well informed and has a say in the therapy as misuse of these drugs is very dangerous<ref>Nilsson N. The prevalence of cervicogenic headache in a random population sample of 20–59-year olds. Spine 1995; 20: 1884–1888. Evidence level: 2C (outcomes research)</ref>.<br>Local injections | ||
The use of local anesthetics or steroids can be indicated when the earlier mentioned medication and heat do not relieve pain and or muscle spasm. | The use of local anesthetics or steroids can be indicated when the earlier mentioned medication and heat do not relieve pain and or muscle spasm. | ||
#Local Muscle infiltration | #Local Muscle infiltration | ||
#Cervical epidural injection | #Cervical epidural injection | ||
#Cervical sympathetic and radicular blockade | #Cervical sympathetic and radicular blockade | ||
=== Surgery === | === Surgery === | ||
In exceptional cases when conservative therapy does not work, surgery can be applied to help patients with chronic and recurrent cervicocephalic syndrome and unbearable pain | In exceptional cases when conservative therapy does not work, surgery can be applied to help patients with chronic and recurrent cervicocephalic syndrome and unbearable pain | ||
== Physical Therapy Management <br> == | == Physical Therapy Management <br> == | ||
Manipulation<ref name="Gross" />: There is moderate evidence for manipulation when this technique is combined with mobilisation of the cervical spine. When manipulation is done, there is just low evidence for pain relief and improvement in function. Thoracic manipulation could be an additional therapy to realise pain reduction. | *Manipulation<ref name="Gross" />: There is moderate evidence for manipulation when this technique is combined with mobilisation of the cervical spine. When manipulation is done, there is just low evidence for pain relief and improvement in function. Thoracic manipulation could be an additional therapy to realise pain reduction. | ||
*Mobilisation: There is low evidence for improvement when only mobilisations are performed during the therapy<ref name="Gross">Gross A. Miller J, D’Sylva J, Burnie S.J, Goldsmith C.H, Graham N, Haines T, Bronfort G, Hoving J.L. Manipulation or mobilisation for neck pain. The Cochrane Library, 12/05/2010. evidence level: 1A (review)</ref><ref name="Kay">Kay T.M, Gross A, Goldsmith C.H, Rutherford S, Voth S, Hovingg J.L, Bronfort G, Santaguida P.L. Exercises for mechanical neck disorders. The Cochrane Library, 15/08/2010. Evidence level: 1A (review)</ref>. There is no difference compared with acupuncture for acute pain reduction<ref name="Gross" /><sup>.</sup> | |||
*Exercise: Stretching and strengthening of the cervical region and the areas around it shows a moderate quality of evidence in pain reduction and improvement in function on short term to intermediate follow-up<ref name="Kay" />. | |||
*Electrotherapy: Very low to low evidence is available that TENS, EMS, pulsed electromagnetic field therapy and repetitive magnetic stimulation show a greater therapy effect compared with a placebo treatment<ref name="Graham">Graham N, Gross A, Goldsmith C.H, Moffett J.K, Haines T, Burnie S.J, Peloso P.M.J. Mechanical traction for neck pain with or without radiculopathy. The Cochrane Library, 17/02/2010. Evidence level: 1A (review)</ref><span style="font-size: 11px;">.</span> | |||
*Patient education: When doing physical exercises with patients, the therapist has to convince the patient about its positive effects to avoid patient’s satisfaction<ref name="Kay" /><span style="font-size: 11px;">.</span> | |||
*Traction: A review based on 7 RCT’s shows no significant difference in pain reducation and daily functioning when a traction therapy is compared with a placebo traction<ref name="Graham" /><span style="font-size: 11px;">.</span><br> | |||
== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) == | == Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) == | ||
<div class="researchbox"><rss>http://www.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=1hSsbZPB1F1uLFyNSo7ekgYkyEplzA2LfntHpDJ5VwCPfTLMns|charset=UTF-8|short|max=10</rss> </div> | |||
<rss> | |||
== References == | == References == | ||
Revision as of 12:41, 31 January 2014
Original Editors
Top Contributors - Laura Ritchie, Elien Lebuf, Pieter Piron, Kim Jackson, Rachael Lowe, Venugopal Pawar, WikiSysop and Admin
Definition/Description[edit | edit source]
A cervicocephalic syndrome is a cervical syndrome associated with deep or superficial pain in the head, dizziness and often visual (nystagmus for example) or auditory disturbances such as tinnitus or dysphagia. The syndrome results in pain and restriction of motion of the upper cervical spine. Cervicocephalic syndrome is therefore different from cervicogenic headache[1].
Clinically Relevant Anatomy[edit | edit source]
The upper cervical complex consists of the occipito-atlantal (C0-C1), the atlanto-axial (C1-C2) and the superior aspect of C2.Those are the atypical segments of the cervical spine. Biomechanically there is a lot of research and study of this region. Although the upper cervical complex works as an integrated region, each level has to be regarded individually to see its contribution to the overall function.
The vertebral arteries begin in the root of the neck, usually the left artery is larger than the right. The cervical parts of the vertebral arteries ascend through the transverse foramina of the first six cervical vertebrae. The dura and arachnoid is perforated by the atlantic parts of the vertebral arteries that pass through the foramen magnum. At the caudal border of the pons the basilar artery is formed out of the intracranial parts of the vertebral arteries[1][2].
Epidemiology /Etiology[edit | edit source]
Impingement on the vertebral artery and the sympathetic nerve near the cervical spine can be related to induces cervicocephalic syndrome. By stimulation of nociceptors in zygapophyseal joints, approximate muscles and tendons the symptoms can be stimulated. The irritations can possibly be caused by malpositioned joints at the head/neck junction, deviations of the cervical spine from the body axis, displacement of vertebrae and constriction of the vertebral artery[3].
Characteristics/Clinical Presentation[edit | edit source]
Cervical headaches affect approximately 2,5% of the adult population and comprise roughly 15 to 20% of all chronic and recurrent headaches (Cervicogenic) headache en neck pain are the two most common complaints reported by patients with cervicocephalic syndrome. Other symptoms associated with the syndrome are dizziness, auditory – and visual disturbance. ‘Cervicocephalic kinesthetic sensibility’ is a common complaint related to chronical neck disorders, mostly accompanied with a decreased postural balance. The ability to recognize movements in the neck is reduced due to a disturbed proprioception.
Differential Diagnosis[edit | edit source]
Many diseases cause headache, differential diagnosis is therefore important. General causes of headache can be ruled out quite easily: metabolic disease, hypertension and visual disturbances. CCS is sometimes erroneously diagnosed as migraine, but differs in many ways from CCS. Common migraine differs from cervicocephalic migraine in duration of each attack as well as the corresponding symptoms such as vomiting and nausea. Other symptoms (dizziness and vestibular disturbances) related to cervicocephalic syndrome can be provoked or worsened by movements of the head and cervical spine, unlike symptoms associated with ordinary dizziness and vestibular disturbances.
Diagnostic Procedures[edit | edit source]
The Cervicogenic Headache Study Group established the following criteria for the diagnosis of CH (Hesselbarth 2005): Provocation by head movements, maintenance of antalgic head posture and (partial) relief of pain by diagnostic blockade. As CCS comprises of cervicogenic headache, the preconceived criteria are therefore of use in the diagnostic procedure of CCS. Complaints such as dizziness and vestibular disturbances arouse with certain head movement as said in previous subtitles. (Kraemer et al.)
Outcome Measures[edit | edit source]
Patients who followed a proprioceptive rehabilitation programme improved a significant in controlling head repositioning accuracy compared with a controle group who didn’t follow this programme[3] But It isn’t clear if the difference in reposition angle also has clinical relevance (2 degrees). Clinical parameters like pain, analgesica intake, ROM and daily functioning are also improved significant in the intervention group[3].
Examination[edit | edit source]
To evaluate the sensibility of head orientation is possible evaluated by relocate the head after an active movement[2]. The patient is asked to relocate the head after an active rotation to the left and right[2][4]. When healthy persons and patients are compared, the patient group indicates significantly worse scores on the test[2]. The validity and test-retest reliability demonstrate an excellent result for measuring the cervical proprioception[4].
Medical Management
[edit | edit source]
Medication[edit | edit source]
As the problem is situated on a biomechanical level. The roll of mediation in purely symptomatic. No evidence is found for influence of the drugs on the volume or consistency of the cervical discs. Despite this fact medication has been proven to be effective because it relieves the patient of his deep and severe pain. Also Sedatives and tranquillizers can be used. Those can lessen the central sensitization of the biomechanical stress. They can also help relieving the night pain which prevents the patient from having not only physical but also emotional stress. The therapy benefits from these results. Important is that medication is only used as an asset to the physical therapy. It’s important that the patient is well informed and has a say in the therapy as misuse of these drugs is very dangerous[5].
Local injections
The use of local anesthetics or steroids can be indicated when the earlier mentioned medication and heat do not relieve pain and or muscle spasm.
- Local Muscle infiltration
- Cervical epidural injection
- Cervical sympathetic and radicular blockade
Surgery[edit | edit source]
In exceptional cases when conservative therapy does not work, surgery can be applied to help patients with chronic and recurrent cervicocephalic syndrome and unbearable pain
Physical Therapy Management
[edit | edit source]
- Manipulation[6]: There is moderate evidence for manipulation when this technique is combined with mobilisation of the cervical spine. When manipulation is done, there is just low evidence for pain relief and improvement in function. Thoracic manipulation could be an additional therapy to realise pain reduction.
- Mobilisation: There is low evidence for improvement when only mobilisations are performed during the therapy[6][7]. There is no difference compared with acupuncture for acute pain reduction[6].
- Exercise: Stretching and strengthening of the cervical region and the areas around it shows a moderate quality of evidence in pain reduction and improvement in function on short term to intermediate follow-up[7].
- Electrotherapy: Very low to low evidence is available that TENS, EMS, pulsed electromagnetic field therapy and repetitive magnetic stimulation show a greater therapy effect compared with a placebo treatment[8].
- Patient education: When doing physical exercises with patients, the therapist has to convince the patient about its positive effects to avoid patient’s satisfaction[7].
- Traction: A review based on 7 RCT’s shows no significant difference in pain reducation and daily functioning when a traction therapy is compared with a placebo traction[8].
Recent Related Research (from Pubmed)[edit | edit source]
References[edit | edit source]
- ↑ 1.0 1.1 Krämer J. Intervertebral Disk Diseases: Causes, Diagnosis, Treatment and Prophylaxis. Stuttgart(2006): Thieme. Grades of recomandation B: (book with references of level 1, 2 and 3)
- ↑ 2.0 2.1 2.2 2.3 Revel M, Andre-Deshays C, Minguet M. Cervicocephalic kinaesthetic sensibility in patients with cervical pain. Arch Phys Med Rehabil. 1991 Apr;72(5):288-91. Evidence level: 1B (RCT)
- ↑ 3.0 3.1 3.2 Revel M, Minguet M, Gregoy P, Vaillant J, Mannuel JL. Changes in cervicocephalic kinesthesia after a proprioceptive rehabilitation program in patients with neck pain: a randomized controlled study. Arch Phys Med Rehabil. 1994 Aug;75(8):895-9. Evidence level: 1B (RCT)
- ↑ 4.0 4.1 Pinsault N, Vuillerme N, Pavan P. Cervicocephalic relocation test to the neutral head position: assessment in bilateral labyrinthine-defective and chronic, nontraumatic neck pain patients. Arch Phys Med Rehabil. December 2008; Vol 89: 2375-2378. Evidence level: 2B (poor RCT)
- ↑ Nilsson N. The prevalence of cervicogenic headache in a random population sample of 20–59-year olds. Spine 1995; 20: 1884–1888. Evidence level: 2C (outcomes research)
- ↑ 6.0 6.1 6.2 Gross A. Miller J, D’Sylva J, Burnie S.J, Goldsmith C.H, Graham N, Haines T, Bronfort G, Hoving J.L. Manipulation or mobilisation for neck pain. The Cochrane Library, 12/05/2010. evidence level: 1A (review)
- ↑ 7.0 7.1 7.2 Kay T.M, Gross A, Goldsmith C.H, Rutherford S, Voth S, Hovingg J.L, Bronfort G, Santaguida P.L. Exercises for mechanical neck disorders. The Cochrane Library, 15/08/2010. Evidence level: 1A (review)
- ↑ 8.0 8.1 Graham N, Gross A, Goldsmith C.H, Moffett J.K, Haines T, Burnie S.J, Peloso P.M.J. Mechanical traction for neck pain with or without radiculopathy. The Cochrane Library, 17/02/2010. Evidence level: 1A (review)
