Cervicocranialgia: a multitude of reasons, but only one issue

F.I. Devlikamova¹, D.Kh. Khaybullina¹, Yu.N. Maximov¹, B.E. Gubeyev^1,2

¹Russian Medical Academy of Continuing Professional Education, Kazan

²Republican Clinical Neurological Center, Kazan

Aim: to identify the functional disorders role of the spinal motion segment (SMS) in the cervical spine and significance clarification of each anatomical structure in the formation of the cervicogenic headache (CGH) clinical picture.

Patients and methods: the study included 110 patients (68 women, 42 men; the average age of all patients — 38.7 ±2.3 years) who complained of neck pain with irradiation to the head. All patients underwent the neurological and neuro-orthopaedic examination. CGH verification was conducted according to the CGH diagnostic criteria recommended by the International Headache Society.

Results: disease duration at the time of visit ranged from 20 days to 11 years. In 91 (82.7%) patients, the headache was unilateral. According to neuro-orthopaedic examination, movement restrictions in the cervical spine were diagnosed in all patients. In the vast majority of cases functional blocking had a concominant character: С₀–С_I and C_I–C_II; С₀–С_I, C_I–C_II and C_VII–Th_I, Th_I–Th_II; C_III–C_IV, Th_I–Th_II–Th_III. In patients with changes in the upper cervical spine (С₀–С_I–С_II), blocking was accompanied by visual and acoustic symptoms, dizziness, suboccipital muscles hypertonicity and the myofascial trigger zones (MTZ) development in the obliquus capitis inferior muscle and rectus capitis lateralis muscles, as well as in the sternocleidomastoid muscle. When blocking SMS C_III–C_IV, the headache had a pronounced vegetative colour, accompanied by nausea and vomiting. Patients with lower cervical spine (C_III–C_VII) blockage were diagnosed with MTZ in the splenius capitis muscle at the level of blocked SMS.

Conclusion: CGH is a heterogeneous group of headaches, one of the main causes of which is functional blocking of the SMS in the cervical spine. The CGH clinical picture depends on the level of the functional blocking site. SMS functional blocking in the cervical spine is accompanied by the MTZ development in the muscles of the neck and suboccipital region.

Keywords: cervicogenic headache, cervical spine, biomechanics, functional disorders, myofascial trigger zones, manual therapy.

For citation: Devlikamova F.I., Khaybullina D.Kh., Maximov Yu.N., Gubeyev B.E. Cervicocranialgia: a multitude of reasons, but only one issue. RMJ. 2019;9:4–10.