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Rehab Grand Rounds Fall 2014

In this issue of Rehab Grand Rounds, Drs. Eric Helm and Robert Donlan join together to explore diagnostic and treatment strategies for cervicogenic headache.

Educational objectives:

Upon completion of this activity, participants should be able to:

  • Identify both common and distinguishing characteristics between cervicogenic headache and the more common migraine headache
  • Describe the proposed pathophysiological basis of cervicogenic headache
  • Discuss specific physical examination maneuvers related to the diagnosis of cervicogenic headache
  • Discuss the role of physical therapy and injections in both the diagnosis and management of cervicogenic headache

Reading Resources:

  1. Stovner LJ, et al. Epidemiology of Headache in Europe. Eur J Neurology,2006; 13: 333-345.
  2. International Headache Society. The International Classification ofHeadache Disorders, 2nd ed. Cephalagia, 2004; 24 (suppl 1): 115-116.
  3. Sjaastad O, Bakketeig, LS. Prevalence of Cervicogenic Headache: VagaStudy of Headache Epidemiology. Acta Neurol Scand, 2008; 117: 173-180.
  4. Suijlekom HA, et al. Quality of Life of Patients With CervicogenicHeadache: A Comparison With Control Subjects and Patients WithMigraine or Tension-type Headache. Headache: The Journal of Head andFace Pain, 2003; 43: 1034-1041.
  5. Vincent MB. Cervicogenic Headache: A Review Comparison WithMigraine, Tension-type Headache, and Whiplash. Curr Pain Headache Rep,2010; 14: 238-243.
  6. Biondi, DM. Cervicogenic Headache: A Review of Diagnostic and TreatmentStrategies. J Am Osteopath Assoc, 2005; 105 (4) suppl 2; S16-S22.
  7. Mehnert MJ, Freedman MK. Update on the Role of Z-joint Injectionand Radiofrequency Neurotomy for Cervicogenic Headache. PM R,2013; 5: 221-227.
  8. Bogduk, N, Govind, J. Cervicogenic headache: An Assessment of theEvidence on Clinical Diagnosis, Invasive Tests, and Treatment. LancetNeurol, 2009; 8: 959-968.
  9. Ferrari R, Russell AS, Carroll LJ, Cassidy JD. A Re-examination of theWhiplash Associated Disorders (WAD) as a Systemic Illness. Ann RheumDis, 2005; 64: 1337-1342.
  10. Tencer AF, Mirza S, Bensel K. Internal Loads in the Cervical Spine DuringMotor Cehicle Rear-end Impacts: The Effect of Acceleration andHead-to-head Restraints Proximity. Spine, 2002; 27: 34-42.


Doctors Helm, Donlan, and Munin have reported no relevant relationships with proprietary entities producing health care goods or services.

Accreditation Statement:

The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The University of Pittsburgh School of Medicine designates this enduring material for a maximum of .5 AMA PRA Category 1 Credits™. Each physician should only claim credit commensurate with the extent of their participation in the activity. Other health care professionals are awarded (0.05) continuing education units (CEU) which are equivalent to .5 contact hour.

For your credit transcript, please access our website 4 weeks post-completion at http://ccehs.upmc.edu and follow the link to the Credit Transcript page. If you do not provide the last 5 digits of your SSN on the next page you will not be able to access a CME credit transcript. Providing your SSN is voluntary.

Release Date: 9/16/2014 | Last Modified On: 11/18/2015 | Expires: 11/18/2016

Additional Resources

VIDEO: Third Occipital Nerve Radiofrequency Ablation


Eric Helm, MD

Eric Helm, MD Department of Physical Medicine & Rehabilitation
Passavant Medical Offices Bldg.
20130 Perry Hwy.
Bldg. 6, Suite 2300
Cranberry Twp., PA 16066
Office Phone: (412) 692-4400
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Robert Donlan, DO

Resident, Department of Physical Medicine and Rehabilitation
University of Pittsburgh School of Medicine
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Michael C. Munin, MD

Michael C. Munin, MD Professor, Department of Physical Medicine and Rehabilitation Medical Director, UPMC Spasticity Evaluation and Treatment Center
Medical Director, Prosthetic Rehabilitation Clinic
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