title: Massaging over the greater occipital nerve reduces the intensity of migraine attacks: evidence for inhibitory trigemino-cervical convergence mechanisms.
abstract: Activation of the trigemino-cervical system constitutes one of the first steps in the genesis of migraine. The objective of this study was to confirm the presence of trigemino-cervical convergence mechanisms and to establish whether such mechanisms may also be of inhibitory origin. We describe a case of a 39-years-old woman suffering from episodic migraine who showed a significant improvement in her frontal headache during migraine attacks if the greater occipital nerve territory was massaged after the appearance of static mechanical allodynia (cortical sensitization). We review trigemino-cervical convergence and diffuse nociceptive inhibitory control (DNIC) mechanisms and suggest that the convergence mechanisms are not only excitatory but also inhibitory.
authors: Neurology Division, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Rua General Carneiro 181, 80060-900 Curitiba, PR, Brazil. piovesan@avalon.sul.com.br
authors: Elcio Juliato
authors: EJ
authors: Piovesan
authors: Fabrizio
authors: F
authors: Di Stani
authors: Pedro André
authors: PA
authors: Kowacs
authors: Rogério Andrade
authors: RA
authors: Mulinari
authors: Victor Hugo
authors: VH
authors: Radunz
authors: Marco
authors: M
authors: Utiumi
authors: Eder B
authors: EB
authors: Muranka
authors: Mario Luiz
authors: ML
authors: Giublin
authors: Lineu César
authors: LC
authors: Werneck
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae / Q000503:physiopathology; D004599:Electric Stimulation Therapy; D005260:Female; D006801:Humans; D008405:Massage; D020326:Migraine without Aura / Q000503:physiopathology / Q000628:therapy*; D009407:Nerve Block / Q000379:methods; D009619:Nociceptors / Q000502:physiology*; D009778:Occipital Lobe / Q000502:physiology*; D010147:Pain Measurement; D012720:Severity of Illness Index; D013997:Time Factors; D014279:Trigeminal Nucleus, Spinal / Q000503:physiopathology*