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Is There Support for the Paradigm ‘Spinal Posture as a Trigger for Episodic Headache’? A Comprehensive Review

  • Sarah MingelsEmail author
  • Wim Dankaerts
  • Marita Granitzer
Hot Topics in Pain and Headache (N. Rosen, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Hot Topics in Pain and Headache

Abstract

Purpose of Review

The International Classification of Headache Disorders provides an extensive framework to classify headaches. Physiotherapy is indicated if neuromusculoskeletal dysfunctions are involved in the pathophysiology. Maladaptive postures seem a dominant trigger in tension-type and cervicogenic headache. Yet, outcomes following physiotherapy vary. The absence of protocol studies to identify determinants concerning the role of spinal posture in headache might explain such variability. Hence, multi-dimensional profiling of patients with headache based on interactions between spinal posture, psychosocial and lifestyle factors might be essential. Therefore, the aim of this paper was to perform a comprehensive review to find support for the paradigm of spinal posture triggering episodic headache based on a multi-dimensional view on tension-type and cervicogenic headache including modern pain neuroscience.

Recent Findings

A review was conducted to support spinal posture-induced episodic headache. Pubmed, Web of Science, Pedro and the Cochrane database were explored based on the following ‘Mesh’ or ‘Topics’: ‘Headache’, ‘Posture’, ‘Spine’, ‘Psychosocial’, ‘Lifestyle’. The contemporary review of neuroanatomical, biomechanical and non-nociceptive pathways, with integration of modern pain neuroscience in tension-type and cervicogenic headache, supports spinal posture as a trigger for episodic headache. Maladaptive postures can activate C1-C3 nociceptors. Convergence with trigeminal afferents at the trigeminocervical nucleus could explain spinal headache. Interactions with psychosocial and lifestyle factors might contribute to peripheral and central sensitisation.

Summary

Neuroanatomical, biomechanical and non-nociceptive pathways seem to justify profiling patients based on a postural trigger. Further research is needed to determine the contribution of postural dysfunctions in headache and the effect of specific interventions.

Keywords

Physiotherapy Spinal posture Neuroanatomy Biopsychosocial Profile Episodic headache 

Abbreviations

TTH

Tension-type headache

CeH

Cervicogenic headache

FHP

Forward head posture

RCPmi

Rectus capitis posterior minor

CS

Central sensitisation

DNIC

Diffuse noxious inhibitory control

HPA

Hypothalamic-pituitary-adrenal

ANS

Autonomic nervous system

PAG

Periaqueductal grey matter

Notes

Compliance with Ethical Standards

Conflict of Interest

Sarah Mingels, Wim Dankaerts, and Marita Granitzer declare no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Sarah Mingels
    • 1
    • 2
    Email author
  • Wim Dankaerts
    • 2
  • Marita Granitzer
    • 1
  1. 1.REVAL Rehabilitation Research Centre, Biomedical Research Institute, Faculty of Rehabilitation SciencesHasselt UniversityHasseltBelgium
  2. 2.Musculoskeletal Research Unit, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation SciencesLeuven UniversityLeuvenBelgium

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