Cervicogenic Headaches

Posted On: May 31, 2017

This is the eleventh case review from my past practice. I am Dr. David Johnson a chiropractor and physical therapist in Highland Park and Lake Bluff. I am the director of North Shore Spinal and Sports Rehabilitation. I have practiced chiropractic and physical therapy on Chicago’s North Shore for almost 30 years. I started as a chiropractor in Lake Forest, Il in 1987. I integrated physical therapy into my practice in 1990.

This is case of a 55 year-old woman complaining of chronic daily headaches. She had been diagnosed as having migraines and was taking a lot of over the counter medications as the triptans had not been developed yet. She did not get an aura or have any known triggers. The headaches would get severe enough to where she would have lay down, though I don’t think she was photophobic.

Interestingly enough she had been involved in a whiplash injury when she was in her twenties, where she injured her neck. She originally was from Europe and had been worked up and managed there.

Like many headache patients she did not have any neurologic signs. Her upper and lower extremity deep tendon reflexes were normal. She had no sensory changes and had good upper extremity strength. She did have limited and painful cervical ranges of motion.

X-rays of her cervical spine revealed some degenerative disc disease with spondylosis (bone spurring) at C5/C6. This kind of degenerative change is common post whiplash injury.

I diagnosed her with cervicogenic headaches. Although in retrospect I could have called it a chronic whiplash related disorder as well, except that this phrase hadn’t been coined as of yet.

I proceeded to treat her with chiropractic manipulation, myofascial release and cervical spine exercises (range of motion, stretching and strengthening). She made an awesome recovery and got virtually headache free. It did take 3-4 months, but the treatment had long lasting effects.

Years later she came back to my clinic with temporal area headaches. She had tenderness over the temporal artery. I ran a sed rate and it was high. I diagnosed her this time with temporal arteritis and sent her to a rheumatologist colleague of mine, who placed her on an oral corticosteroid and she recovered again.