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

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.

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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

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Correspondence to Sarah Mingels.

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Mingels, S., Dankaerts, W. & Granitzer, M. Is There Support for the Paradigm ‘Spinal Posture as a Trigger for Episodic Headache’? A Comprehensive Review. Curr Pain Headache Rep 23, 17 (2019). https://doi.org/10.1007/s11916-019-0756-2

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Keywords

  • Physiotherapy
  • Spinal posture
  • Neuroanatomy
  • Biopsychosocial
  • Profile
  • Episodic headache