Cervicocephalic syndrome

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Cervicocephalic syndrome, Cervical syndrome, Back pain, Cervicogenic headache, neck pain, physical therapy, exercise,

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 cervicogenic headache. (See: http://www.physio-pedia.com/Cervicogenic_Headache) (2)

Clinically Relevant Anatomy

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. (2,4)

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. (3)

Characteristics/Clinical Presentation

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

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

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

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 (Revel et al.).(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

To evaluate the sensibility of head orientation is possible evaluated by relocate the head after an active movement.(4) The patient is asked to relocate the head after an active rotation to the left and right.(4,5) When healthy persons and patients are compared, the patient group indicates significantly worse scores on the test.(4) The validity and test-retest reliability demonstrate an excellent result for measuring the cervical proprioception (Pinsault et al.).(5)

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