Abstract
Objective: To examine the neurophysiologic basis and anatomic relationship between the dura
mater and the rectus capitis posterior minor muscle in the etiologic proposition of
cervicogenic headache. Data Source: On-line searches in MEDLINE and the Index to Chiropractic Literature, manual citation
searches, and peer inquiries. Results: Connective tissue bridges were noted at the atlanto-occipital junction between the
rectus capitis posterior minor muscle and the dorsal spinal dura. The perpendicular
arrangement of these fibers appears to restrict dural movement toward the spinal cord.
The ligamentum nuchae was found to be continuous with the posterior cervical spinal
dura and the lateral portion of the occipital bone. Anatomic structures inervated
by ceervical nerves C1–C3 have the potential to cause headache pain. Included are
the joint complexes of the upper 3 cervical segments, the dura mater, and spinal cord.
Conclusion: A sizable body of clinical studies note the effect of manipulation on headache. These
results support its effectiveness. The dura-mascular, dura-ligamentous connections
in the upper cervical spine and occipital areas may provide anatomic and physiologic
answers to the cause of the cervicogenic headache. This proposal would further explain
manipulation's efficacy in the treatment of cervicogenic headache. Further studies
in this area are warranted to better define the mechanisms of this anatomic relationship.
(J Manipulative Physiol Ther 1999;22:534–9).
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Manipulative & Physiological TherapeuticsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Joint complex dysfunction, a novel term to replace subluxation/subluxation complex: etiological and treatment considerations.J Manipulative Physiol Ther. 1997; 20: 634-644
- Spinal manipulation vs. amitriptyline for the treatment of chronic tension-type headaches: a randomized clinical trial.J Manipulative Physiol Ther. 1995; 18: 148-154
- Pain and “hassles” in the United States: findings of the Nuprin pain report.Pain. 1986; 27: 69-80
- Headache as the reason for the office visits: National Ambulatory Medical Care Survey, United States, 1977–78.NCHC Adv-Data. 1981; 67: 1-6
- Measuring the functional status and well-being of patients with migraine headache.Headache. 1994; 34: 337-343
- Unconventional medicine in the United States: prevalence, costs, and patterns of use.N Engl J Med. 1993; 328: 246-252
- Classification and diagnosis criteria for headache disorders, cranial neuralgias, and facial pain.International Headache Society, Copenhagen1990
- The anatomical basis for cervicogenic headache.J Manipulative Physiol Ther. 1992; 15: 67-70
- Anatomic relation between the rectus capitis posterior minor muscle and the dura mater.Spine. 1995; 20: 2484-2486
- Formation documents.1995
- Spinal manipulations and headaches: an update.Top Clin Chiro. 1995; 2: 34-47
- Vascular compression of the C2 roots-yet another cause of chronic intermittent hemicrania?.Cephalgia. 1984; 4: 167-170
- Studies in cervical spondylolytic myelopathy.Brain. 1971; 94: 557-568
- Neck and arm pain.3rd ed. F.A. Davis, Philadelphia1991
- Functional pathology of the cervical spine.Excerpta Medical Foundation, Amsterdam1968
- Spinal cord intra-medullary pressure.Spine. 1994; 19: 2174-2179
- Posterior cervical dura is much thicker that the anterior posterior dura.Spine. 1996; 21 ([comment]): 2300-2301
- MRI of normal and atrophic muscles of the upper cervical spine.J Clin Engineering. 1993; 18: 433-439
- Cervicogenic headache.in: Foundations of chiropractic subluxation. Mosby, St Louis1995: 306-316
- Anatomic relation between the rectus capitis posterior minor muscle and the dura mater.Spine. 1997; 22 ([comment]): 924-925
- Visualization of the muscle-dural bridge in the visible human dataset.in: Proceedings of the Visible Human Project Conference, National Institutes of Health, Bethesda, MarylandOctober 1996
- Rectus capitis posterior minor-dura connective tissue bridges: an anatomical study with MRI correlation.in: Proceedings of the American Society of Head and Neck Radiology, Los Angeles, CaliforniaApril 1996
- Attachments of the ligamentum nuchae to cervical posterior spinal dura and the lateral part of the occipital bone.J Manipulative Physiol Ther. 1998; 21: 145-148
- The ligamentum craniale durae matris spinalis ligament may contribute to the prevention of dural enfolding.Spine. 1997; 22 ([In response]): 925-926
- Craniosacral therapy.Eastland Press, Seattle1983
- Chronic zygapophyseal joint pain after whiplash: a placebo-controlled prevalence study.Spine. 1996; 21: 1736-11733
- Isolated muscle atrophy of the distal upper extremity in cervical spinal cord compressive disorders.J Spinal Disord. 1995; 8: 311-316
- Cervical causes of headache and dizziness.in: Modern manual therapy of the vertebral column. Churchill-Livingstone, Edinburgh, England1986: 289-302
- Cervical zygapophyseal joint pain patterns. I. A study in normal volunteers.Spine. 1990; 15: 453-457
- Cervicogenic dysfunction in muscle contraction headache and migraine: a descriptive study.J Manipulative Physiol Ther. 1992; 15: 418-429
- Chiropractic management of spine related disorders.in: Williams & Wilkins, Baltimore1990: 249-253
- Roentgenographic findings of the cervical spine in tension-type headaches.Headache. 1993; 2: 90-95
- Tension headache.in: Handbook of clinical neurology. vol 5. North-Holland Publishing Company, Amsterdam1968: 157-171
- Basic and clinical anatomy of the spine, spinal cord, and ANS.in: Mosby, St Louis1995: 142-143
- Contribution of central neuroplasticity to pathological pain: review of clinical and experimental evidence.Pain. 1993; 52: 259-285
- Definitions and taxonomy of pain.in: 2nd ed. The management of pain. Lea & Febiger, Philadelphia1990: 18-27
- Organization of pain pathways.in: Diseases of the nervous system: clinical neurobiology. WB Saunders, Philadelphia1992: 849-857
- Spinal cord neuronal plasticity: mechanisms of persistent pain following tissue damage and nerve injury.in: New trends in referred pain and hyperalgesia. Elsevier, New York1993: 109-117
- Spinal cord mechanisms of referred pain and related neuroplasticity.in: Foundations of chiropractic: subluxation. Mosby, St Louis1995: 279-301
- Neural plasticity.in: Diseases of the nervous system: clinical neurobiology. WB Saunders, Philadelphia1992: 63-71
- Deafferentation: a novel term to describe the neuropathophysiological effects of joint complex dysfunction. A look at likely mechanisms of symptom generation.J Manipulative Physiol Ther. 1998; 21: 267-280
- Physiological, inflammatory and neuropathic pain.Adv Tech Stand Neurosurg. 1987; 15: 39-62
- Cervical headache.Med J Aust. 1985; 143: 202-207
- The effect of spinal manipulation in the treatment of cervicogenic headache.J Manipulative Physiol Ther. 1997; 20: 326-330
- Ligament pain and anteflexion headache.Eur Neurol. 1971; 5: 356-378
- Occipital headaches: statistical results in the treatment of vertebrogenic headache.Ann Swiss Chiro Assoc. 1985; 8: 127-136
- Mobilization of the cervical spine in chronic headaches.Manual Med. 1987; 3: 15-17
- The effect of manipulation (toggle recoil technique) for headaches with upper cervical joint dysfunction: a pilot study.J Manipulative Physiol Ther. 1994; 17: 369-374
- A controlled trial of manipulation for migraine.Aust N Z J Med. 1978; 8: 589-593
- An open study comparing manual therapy with the use of cold packs in the treatment of post-traumatic headache.Cephalalgia. 1990; 10: 241-250
- Comments regarding the diagnosis and treatment of dysfunctions of the C2–C3 segment.Manual Med. 1985; 2: 16-17
- Chiro-practic treatment of chronic episode tension-type headache in male subjects: a case series analysis.J Can Chiro Assoc. 1994; 38: 152-159
- Manual therapy in the treatment of patients with cervical migraine.Manual Med. 1989; 4: 49-51
- Manipulative therapy in the chiropractic treatment of headaches: a retrospective and prospective study.J Manipulative Physiol Ther. 1982; 5: 109-112
- Migraine: a statistical analysis of chiropractic treatment.Chiro J. 1978; 12: 363-367
Article info
Publication history
Received in revised form:
February 2,
1999
Received:
December 22,
1998
Footnotes
☆Submit requests for reprints to: Matthew E. Alix, DC, 2746 Festival Ln, Dublin, OH 43017; [email protected]
Identification
Copyright
© 1999 JMPT. Published by Elsevier Inc. All rights reserved.
