A large portion of the population will experience headaches at some point in their lives. About 17% of these are classified as cervicogenic headaches, or headaches originating from the neck. Physical therapists can be instrumental in screening out more serious issues as part of a comprehensive evaluation. This article describes a physical therapy examination and decision to refer a patient to the proper medical provider.

Physical therapy examinations measure neck range of motion, neck strength, presence of muscle tension and neurological screening. In this article, the author describes a 23 year old female patient experiencing right sided, pounding headaches for the past 2 years, with symptoms usually peaking at noontime, and often associated with excessive fatigue. Upon examination, the therapist noted hypersensitive neck muscles and an onset of neurological symptoms (numbness of the toes) with certain neck tests. The patient was referred back to the medical doctor for follow up evaluation and imaging. 

Upon examination by the medical doctor, the imaging demonstrated Klippel-Feil fusion of the neck. Klippel-Feil fusion is when 2 or more neck joints are fused. This is often associated with additional abnormalities including cardiovascular system, facial asymmetry, hearing loss, spinal cord issues, spina bifida and cervical stenosis. The cause can be attributed to excessive movement at the time of ossification (bone hardening) of the cartilage-like dens (see picture). This results in impingement of the spinal cord or vertebral artery due to a change in joint mechanics.