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Comparison of neck vertebrae in patients with and without “cervicogenic” headache

PainSci » bibliography » Masharawi et al 2021
Tags: etiology, hda, neck, pro, head/neck, spine

One article on PainSci cites Masharawi 2021: The Complete Guide to Chronic Tension Headaches

PainSci commentary on Masharawi 2021: ?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

Researchers took CT scans of 80 people aged 20-40, and measured many specific features of their cervical spines, many thousands of measurements in all. Forty of the subjects were headache free, while the other forty not only had headaches, but seemingly very cervicogenic headaches — confirmed by cervical nerve block, no less. If the condition of the spine has anything to do with headaches, you might well expect to see some differences in these patients. But no differences at all were found, and the obvious interpretation is that the shape of the bones the spine has nothing to do with headaches, or there would be at least some sign of it here.

But the obvious interpretation isn’t the only interpretation. The study was limited by studying only the bone shapes of relatively young people, and the negative result was predictable, if not downright expected. It isn’t actually plausible that there would be a visible link between headache and signs of arthritic degeneration in people in the first half of their lives. Even in older people, there are too many factors in pain that have nothing to do with the shape of bones to rule out a cervical driver of pain by bone condition alone. There are plenty of ways that necks could still hurt — and radiate that pain to the head — without anything showing up on 40 CT scans, no matter how painstakingly measured and analyzed.

For a detailed review of this experiment and its significance, see “No obvious neck abnormalities in headache patients,” or the PainSci headache book.

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

As some researchers theorized that cervicogenic headache (CEH) might be related to bony and discal features of the cervical spine, this retrospective study examined the shapes of the cervical vertebrae and intervertebral discs (IVDs) of individuals with CEH and compared them to asymptomatic controls. Scans of 40 subjects in their late 20's-mid 30's affected with CEH and 40 asymptomatic controls were obtained (overall = 19,040 measurements, age-sex matched, 20 males and 20 females in each group). The following cervical spine variables were measured: Supine lordosis, vertebral body-heights, A-P lengths, mediolateral widths and sagittal-wedging; IVDs heights and sagittal-wedging; pedicle heights, widths and transverse angles; laminar widths and transverse angles; articular facet angles, spinal canal, and transverse foramen lengths, widths, and areas. Both groups had similar shape variation along the cervical in all the measured parameters. There were no significant left-right differences in all measured parameters and no significant differences between the CEH and control groups concerning sex and age. Cervical IVDs were lordotic in shape, whereas their adjacent vertebral bodies were kyphotic in shape except for C2. In conclusion, the shape of the cervical spine and IVDs in subjects in their late 20's-mid 30's affected with CEH is identical to asymptomatic controls.

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