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Management of Cervicogenic Headaches

Step 1: Conducting an appropriate clinical evaluation

Step 1a: Conduct an appropriate clinical evaluation

Rule out major structural or other pathologies as the cause of the symptoms.

Risk factors for serious pathologies (also known as red flags) identified during the history and examination warrants further investigation and referral to the appropriate healthcare provider. Once pathology has been ruled out, the patient should be treated according to the shoulder pain care pathway. 

Step 1b: Risk factors for serious pathology (also known as red flags)

Unexplained deformity or swelling or erythema of the skin; significant weakness not due to pain; past history of malignancy; suspected malignancy (e.g., weight loss or loss of appetite); fever/chills/malaise; significant unexplained sensory/motor deficits; pulmonary or vascular compromise; inability to perform any movements; pain at rest.

Risk factors for serious pathologies (also known as red flags) identified during the history and examination warrants further investigation and referral to the appropriate healthcare provider. Once pathology has been ruled out, the patient should be treated according to the shoulder pain care pathway. 

Rule out risk factors for serious pathology

If risk factors are present, refer to appropriate services for care.

Conduct ongoing assessment for symptom improvement or progression during intervention and refer accordingly. After additional assessment, and serious pathologies have been ruled out, continue to Step 1c.

Step 1c: Does your patient have other conditions (e.g., physical or mental health conditions or co-morbidities)?

If other conditions are present, manage patients using all appropriate care pathways and co-manage with other appropriate healthcare services.

Step 1d: Assess the patient for poor prognostic factors

Assess the prognostic factors for delayed recovery. Most patients recover from their injury. Patients with the following prognostic factors may have a higher risk for delayed recovery:

  • depression

  • passive coping strategies

  • job dissatisfaction

  • high disability levels

  • disputed compensation claims 

  • somatization

If poor prognostic factors are present, develop a patient-centered care plan with the patient 

  • Educate and reassure about the benign and self-limiting nature of non-specific low back pain and the importance of maintaining activity and movement

  • Address prognostic factors for poor recovery

  • Reassure that it is normal to feel some anxiety, distress or anger. Listen to the patient's concerns, discuss them and adjust the care plan accordingly

Continue to Step 2:

Offer information on nature, management, course of cervicogenic headaches as a framework for initiation of a program of care