Sub-occipital Headache

Dan Murphy, DC

Private Practice of Chiropractic;
Diplomate American Board of Chiropractic Orthopedist;
Faculty Life Chiropractic College West;
Vice President ICA 2003-2009;

ICA Chiropractor of the Year 2009

INTRODUCTION

            All headaches synapse in the Trigeminocervical Nucleus (1):

            The 4 suboccipital muscles are innervated by the posterior primary rami of the C1 nerve root (1):

 

            Three of the suboccipital muscles are directly and firmly attached to the spinal dura mater (2, 3, 4, 5, 6):

• ·      Rectus Capitis Posterior Major (C2 spinous process to the occiput)
• ·      Rectus Capitis Posterior Minor (posterior arch C1 to the occiput)
• ·      Obliquus Capitis Inferior (C2 spinous process to the transverse process of C1)

DISCUSSION

The apparent function of the attachment of the suboccipital muscles is to prevent the cervical spine Dura Mater from being mechanically irritated, injured or inflamed during spinal motions.

The cervical spinal Dura Mater is innervated with pain afferents (nociceptors) from the upper cervical spine nerve roots.

Upper cervical spine nerve root nociceptors synapse in the Trigeminocervical nucleus, and are therefore capable of initiating an electrical signal in the brain interpreted as being headache.

Mechanical dysfunctions of the upper cervical spine may compromise the ability of the suboccipital muscles to protect the Dura Mater from motion related stress, irritation, injury, and inflammation.

Whiplash extension injuries occur quickly, so that the suboccipital muscles do not have enough time to contract and pull the spinal Dura Mater to safety, resulting in injury and headache.

In chronic whiplash patients, injured suboccipital muscles may undergo atrophy and fatty infiltration, further compromising the ability of these muscles to protect the dura mater from irritation and inflammation during routine motions, resulting in headache (7).

DISCUSSION

Chronic upper neck postural stress and distortions that invoke contraction of the suboccipital muscles may cause chronic stress on the spinal dura mater, resulting in headache. This is particularly important in postural techniques, such as Chiropractic Biophysics.

Mechanical dysfunctions of the upper cervical spine may also irritate/inflame the spinal cord and its blood supply because the Dura Mater is attached to the vascular Pia Mater that surrounds the spinal cord (8).

There is biological plausibility for upper cervical spinal manipulation, occiput-atlas-axis chiropractic alignment, postural improvement, and suboccipital muscle myotherapy to be utilized in the cervicogenic headache patient.

References

1. Bogduk N; Anatomy and Physiology of Headache; Biomedicine and Pharmacotherapy; 1995, Vol. 49, No. 10, 435-445.
2. Hack G, Koritzer R, Robinson W, Hallgren R, Greenman P; Anatomic Relation Between the Rectus Capitis Posterior Minor and the Dura Matter; Spine; December 1, 1995; Vol. 20; No. 23; pp. 2484-2486.
3. Rutten HP, Szpak K, van Mameren H, Ten Holter J, deJong J; Letters: comment on Anatomic Relation Between the Rectus Capitis Posterior Minor and the Dura Matter; Spine, April 15, 1997; Vol. 22; No. 8; pp. 924-926.
4. Alix ME, Bates DK; A proposed etiology of cervicogenic headache: the neurophysiologic basis and anatomic relationship between the dura mater and the rectus posterior capitis minor muscle; Journal of Manipulative and Physiological Therapeutics; October 1999. Vol. 22; No. 8; pp. 534-539.
5. Nash L, Nicholson H, Lee ASJ, Johnson GM, Zhang M; Configuration of the Connective Tissue in the Posterior Atlanto-Occipital Interspace; Spine; Volume 30(12) June 15, 2005 pp. 1359-1366
6. Scal F, Marsili ES, Pontell ME; Anatomical Connection Between the Rectus Capitis Posterior Major and the Dura Mater; Spine; December 1, 2011; Vol. 36; No. 25, pp. E1612–E1614.
7. Hallgren RC, Greenman PE, Rechtien JJ; Atrophy of suboccipital muscles in patients with chronic pain: a pilot study; Journal of the American Osteopathic Association; 1994 Dec;94(12):1032-8.
8. White AA, Panjabi M; Clinical Biomechanics of the Spine; Second edition; Lippincott; Phildelphia; 1990.