title: Cervicogenic dysfunction in muscle contraction headache and migraine: a descriptive study.
abstract: OBJECTIVE
  The prevalence and nature of findings of cervicogenic dysfunction is explored in subjects with muscle contraction/tension-type (MCH) headache and common migraine without aura (CM).
  
  
  METHODS
  Descriptive survey.
  
  
  METHODS
  Chiropractic outpatient research clinic.
  
  
  METHODS
  Forty-seven (47) subjects, aged 18-55 with two categories of benign headache, were studied: MCH (tension-type) n = 19 (6 males, 13 females) and CM (without aura), n = 28 (3 males, 25 females). Subjects were recruited as part of an intervention trial and, thus, form a consecutive sample of patients. The present findings were elicited as part of the initial assessment.
  
  
  METHODS
  No therapeutic intervention is reported.
  
  
  METHODS
  Standardized headache history; plain film and dynamic spinal X rays; motion palpation; and pressure algometry.
  
  
  RESULTS
  For CM, the most prevalent headache locations were frontal (81%) and occipital (78%). Neck pain and upper back pain accompanied headache in 90% and 41% of subjects, respectively. For MCH, the most prevalent headache locations were occipital (87%) and frontal (81%). Neck and upper back pain accompanied headache in 100% and 27%, respectively, of all subjects. For the total group, 77% of all subjects and 89% of females exhibited a marked reduction, absence or reversal of the normal cervical lordosis. Ninety-seven percent of all subjects exhibited, on dynamic X-ray studies, at least one significant abnormality of segmental mobility from C1 to C7, while 43% exhibited abnormalities at four or more segments. Segmental motion at C0-C1 was reduced in 90% of subjects in flexion and 70% of subjects in extension. On motion palpation, 84% of CM and MCH subjects were found to have at least two major fixations from C0 to C2. On pressure algometry, 92% of CM and 85% of MCH had at least one verifiable tender point (TP) in the upper cervical region. The most common locations for TPs were mid-cervical (C2-C3), lateral occipital and suboccipital.
  
  
  CONCLUSIONS
  Both MCH and CM subjects demonstrate high occurrences of: a) occipital and neck pain during headaches; b) tender points in the upper cervical region; c) greatly reduced or absent cervical curve; and d) X-ray evidence of joint dysfunction in the upper and lower cervical spine. These findings support the premise that the neck plays an important, but largely ignored role in the manifestation of adult benign headaches. A case-control study should be conducted to confirm the greater prevalence of cervicogenic dysfunction in headache as compared to nonheadache subjects.
authors.affiliation: Center for the Study of Spinal Health, Canadian Memorial Chiropractic College, Toronto, Ontario.
authors.forename: H
authors.initials: H
authors.lastname: Vernon
authors.forename: I
authors.initials: I
authors.lastname: Steiman
authors.forename: C
authors.initials: C
authors.lastname: Hagino
mesh_terms: D000293:Adolescent; D000328:Adult; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005260:Female; D006261:Headache / Q000503:physiopathology*; D006801:Humans; D007596:Joints / Q000503:physiopathology; D008141:Lordosis / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000503:physiopathology*; D009119:Muscle Contraction / Q000502:physiology*; D010146:Pain / Q000209:etiology; D010173:Palpation / Q000379:methods; D015995:Prevalence; D011859:Radiography