Neural Tissue, Motor Control and Treating Cervicogenic Headache

Autopsy findings from James Taylor show C1-2 meniscus entrapment with bleeding around the dorsal root ganglion, a possible source of neural sensitization and neuropathic pain. Toby uses three steps to assess neural mechanosensitivity: active upper cervical retraction or flexion with overpressure in long sitting, neurodynamic testing in supine with the arms abducted aiming to reproduce the headache, and palpation of the greater, lesser and third occipital nerves. Motor control impairments, including poor postural and dynamic control, weakness, reduced endurance and trigger points, matter in cervicogenic and tension-type headache. Work by Harry von Piekartz shows that treating the temporomandibular joint together with the neck gives better results than treating the neck alone. Treatment aims to lower TCN sensitization. Education, sleep, stress and anxiety, medication reduction, diet triggers and comorbidities all matter, and one study found sleep quality was the strongest factor in recovery from neck problems. Mobilization, such as the Mulligan approach, and manipulation are effective, and loading exercise or motor control training is chosen to suit the patient. Nine to 12 sessions are usually enough for lasting change.