The behaviour of head pain is a dead giveaway to identifying cervicogenic head pain, and this can be done within the first 3 minutes of your initial consult (if you start with the body chart (BC)).
So, not surprisingly, I start with the BC.
Let’s assume we are dealing with unilateral head pain.
Unilateral Side-locked Head Pain
Side-locked unilateral head pain has been a hallmark diagnostic criterion of cervicogenic headache (CGH). Whilst this can be the case, it doesn’t rule out (nor does it pretend to) an underlying medical condition, e.g., Giant cell arteritis/Cranial vasculitis.
It has been interesting to observe over the past decade a gradual softening of this, which was an uncompromising criterion, to allow some radiation on the other side. Indeed, “it may be bilateral if severe.”[1] p.3
Alternating/Sideshifting Head Pain
But what of alternating or sideshift of unilateral head pain? In my experience, this behaviour confirms upper cervical musculoskeletal misbehaviour, i.e., CGH. However, the medical model’s perspective, without any explanation of the mechanism, is that this behaviour rules out CGH.
As manual therapists, we witness alternating pain in the low back, medial scapular, or shoulder, among other areas. This alternating pain originates from a ‘central’ musculoskeletal issue; compelling research has demonstrated that aberrant intradiscal behaviour is responsible for alternating low back pain.
Thankfully, as with sidelocked unilaterality, the tide is turning… “cases of ‘unilaterality on two sides’ may be acceptable.”[1] p.3 … another way of describing alternating or sideshift of unilateral head pain.
Transitory Unilateral Head Pain
I refer to unilateral head pain that, as the headache progresses, radiates, i.e., ‘transitions’, to include the other side without leaving the original side as ‘transitory unilateral head pain’. This is in contrast to alternating or sideshift head pain, which occurs exclusively on one side.
Transitory unilateral head pain transitions to become bilateral; this behaviour confirms upper cervical musculoskeletal misbehaviour, i.e., CGH.
Identifying this behaviour requires nuanced questioning and is critical to differentiate from alternating or sideshifting behaviour because the treatment for transitory unilaterality is very different from that for alternating/sideshifting head pain.
Summary:
Sidelocked Unilaterality may be CGH.
Alternating or Sideshift Unilaterality confirms CGH.
Transitory Unilaterality confirms CGH.
Reference:
- Piovesan, E.J., M.A.T. Utiumi, and D.B. Grossi, Cervicogenic headache – How to recognize and treat. Best Pract Res Clin Rheumatol, 2024: p. 101931.
Clinical Perspectives’ are informed by Dr. Dean Watson’s (PhD) 40,000 hours of clinical experience exclusively dedicated to understanding the upper cervical afferents and their relationship to cervicogenic and primary headache syndromes, as well as their comorbid conditions, through the treatment of over 14,000 patients.
