At the doc’s the other day (the one who recommends 2 squares of good quality dark chocolate a day), he also mentioned he thought my dizziness might be triggered by something in my neck (I’d mentioned looking up can make me dizzier). Well recently I’ve been very sceptical about cervical migraine, especially after visiting a chiropractor, and reading up about the philosophy of chiropractic and thinking it a bit, well, quackish (sorry to any chiros here and I hope I don’t get accused of libel :lol: ). Also, I read what Scott had to say which sort of confirmed my scepticism:
Yes, cervicogenic vertigo exists in the medical literature but it is extremely rare and usually shows up after whiplash injuries. Furthermore, there are no nerves running through the neck that directly impact the vestibular system (according to Steve Novella, neurologist)
However, a few things I’ve observed makes me retain some belief in the possibilty there is a neck connection, i.e. neck pain is not only a symptom of migraine, but may, just may, for some of us perhaps, be one of several triggers for it (and I don’t mean a cause). These are:
- I’ve noticed I get dizzy often the day after I’ve been to a Pilates class and done the One Hundreds (this involves neck strain)
- I have a round basket chair which has no neck support and on the few occasions when I’ve sat in it and used my laptop, I’ve developed dizziness later.
- The phenomenon of ‘tall building syndrome’ (aka Golden Gate Syndrome’) or ‘hairdresser’s syndrome’ (as they are sometimes flippantly called), when otherwise healthy individuals have suffered a stroke following prolonged neck extension e.g when having hair washed at the salon or looking up at buildings. This is due to dissection of the internal carotid artery. As a therapist who treats stroke patients I have had 3 patients (all young and fit) who had this, as well as a friend who had a stroke (no risk factors) following an afternoon painting her ceiling. And there are of course the tales of strokes following chiropractic manipulation. A ‘kink’ in the neck arteries is affecting blood flow to the brain.
Moving away then from chiropractiic theories of subluxation etc. which all sound a bit unscientific, I had a look to see if there was anything published by mainstream medicine about this, and found 3 particularly interesting papers, one by neurologists and the others by neurophysiotherapists.
Cervical muscles in the pathogenesis of migraine headache, by Elliot Shevel and Egilius H. Spierings, in The Journal of Headache and Pain, Volume 5, Number 1 / April, 2004. Here’s the abstract:
The pathogenesis of migraine headache is poorly understood but the trigeminovascular system seems to play an important role in it. The trigeminal nucleus caudalis is sensitised by noxious sensory stimuli, often from convergent afferents originating from a variety of tissues. In this paper, we review evidence to support the view that the cervical muscles play a role in the pathogenesis of the migraine headache as well by facilitating the mechanism of central sensitisation.
I’ve read the whole paper and this bit’s the interesting bit:
The trigeminocervical nucleus is the area in the upper cervical spinal cord where sensory nerve fibres in the descending tract of the trigeminal nerve converge with sensory fibres from the upper cervical nerve roots. In this nucleus, a considerable population of neurones demonstrates convergent input from the intracranial dura mater as well as from the cervical muscles. This convergence of trigeminal and upper-cervical nociceptive pathways suggests the existence of a functional continuum between the trigeminal and upper-cervical segments involved in cranial nociception and, thus, headache. Consequently, afferent nociceptive input from tight and sore or painful neck muscles innervated by the upper cervical nerve roots may contribute to the activation of the trigeminovascular, neuroinflammatory cascade.
Cervicogenic dizziness – musculoskeletal findings before and after treatment and long-term outcome, by EVA-MAJ MALMSTROM, MIKAEL KARLBERG, AGNETA MELANDER, MANS MAGNUSSON3 & ULRICH MORITZ in Disability and Rehabilitation, August 2007; 29(15): 1193 – 1205
Purpose. To explore musculoskeletal findings in patients with cervicogenic dizziness and how these findings relate to pain and dizziness. To study treatment effects and long-term symptom progress.
Method. Twenty-two patients (20 women, 2 men; mean age 37 years) with suspected cervicogenic dizziness underwent a structured physical examination before and after physiotherapy guided by the musculoskeletal findings. Questionnaires were sent to the patients six months and two years after treatment.
Results. Dorsal neck muscle tenderness and tightness was found in a majority of the patients. Zygapophyseal joint tenderness was found at all cervical levels. Cervical range of motion was equal to or larger than expected age and gender matched values. The cervico-thoracic region was often hypomobile. Most patients had postural imbalance. Dynamic stabilization capacity was reduced. Suboccipital muscles tightness correlated with posture imbalance and poor neck stability. The treatment resulted in reduced tenderness in levator scapula, high and middle paraspinal and temporalis muscles and zygapophyseal joints at C4-C7 and increased cervico-thoracic mobility. Reduction of middle paraspinal muscle tenderness correlated with neck pain relief. Postural alignment improved, as did dynamic stabilization in trunk, neck and shoulders. After 6 months, 13 of the 17 patients had still no or less neck pain and 14 had no or less dizziness. After 2 years, 7 patients had no or less neck pain and 11 no or less dizziness.
Conclusion. Patients with suspected cervicogenic dizziness have some musculoskeletal findings in common. Treatment based on these findings reduces neck pain as well as dizziness long-term but some patients might need a maintenance strategy.
Diagnosis of Cervicogenic Headache by Gwendolen Jull, PhD, FACP Professor of Physiotherapy, The University of Queensland, Australia in The Journal of Manual & Manipulative Therapy Vol. 14 No. 3 (2006), 136 - 138
Especially this bit:
*Of particular interest to physical therapists is the fact that neck pain accompanies 60-70% of all headache types; it is not a feature unique to cervicogenic headache. For instance, in a large cross-sectional, population-based study of 51,050 persons, Hagan et al found that the incidence of neck pain
associated with migraine headache was twice that for persons with non-migrainous headache. There is familiarity with the trigeminocervical nucleus underlying the physiological basis for an upper cervical disorder referring pain into the head; however, recent research has shown that there are bi-directional interactions between trigeminal afferents and afferents from the three upper cervical nerves in the trigeminocervical nucleus. In other words, nociception from a trigeminal source can be perceived as pain in the neck and this bi-directionality can explain the occurrence of neck pain as one possible symptom of migraine.
Anyway, I’m not saying these are particularly good research papers or anything but I’m thinking that just as say, red wine, cheese, 3D movies, and stress can ‘trigger’ a migraine in someone with a low threshold, maybe neck extension can also act as a trigger by nociception of the trigeminal cervical nucleus, leading to activation of the trigeminovascular, neuroinflammatory cascade.
And in case anyone’s wondering, here’s a good definiton of nociception from Wiki: “the neural processes of encoding and processing noxious stimuli”.
And that’s my research for the evening done :lol: Going to watch Flash Forward now - I love the way it’s full of Brits with American accents.