Klinische Bilder, (Differenzial‑)Diagnostik und therapeutisches Management funktioneller Kopfgelenkstörungen

Functional disorders in the region of the upper cervical joints, often subsumed under the term cervicocephalic syndrome, frequently manifest as a wide array of patient complaints. These range from headache, balance disorders (dizziness), nonspecific ocular and aural symptoms, globus sensation, and vegetive disorders such as sweating and nausea, to “feeling blue” and concentration disorders. Neurophysiologically, this symptom complex is explained under the umbrella term “trigeminocervical convergence.” Nowadays, the existence of cervicogenic dizziness and cervicogenic headache is recognized by guidelines and specialist societies. Diagnosis is based on subtle medical history, examination, and orienting functional assessment and palpation, particularly on the so-called three-step diagnostic pathway (mobility, irritation, provocation). Via this three-step diagnostic process, the blockade can be defined as a hypomobile (hypormobile) reversible dysfunction with an irritation point (hypertonia of the segmentally organized muscles), with at least one nociceptive-free direction in the provocation test. Differential diagnoses, in particular serious diseases of vascular genesis, are of utmost importance. Alongside mobilization and soft tissue or muscle energy techniques, therapeutic measures include manipulation by physicians. Common contraindications must be respected when selecting treatment. To avoid recurrences, attention should be paid to the potential existence of other clinically asymptomatic blockages along the spine, myofascial pathologies, organ diseases without a spinal genesis, work and leisure activities, as well as psychosocial aspects in particular.