Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.
Department of Orthopaedics, Duke University, Department of Population Health Sciences, Duke Clinical Research Institute, Durham, NC, USA.
Musculoskelet Sci Pract. 2023 Aug;66:102780. doi: 10.1016/j.msksp.2023.102780. Epub 2023 May 29.
The concept that headaches may originate in the cervical spine has been discussed over decades and is still a matter of debate. The cervical spine has been traditionally linked to cervicogenic headache; however, current evidence supports the presence of cervical musculoskeletal dysfunctions also in tension-type headache.
This position paper discusses the most updated clinical and evidence-based data about the cervical spine in tension-type headache.
Subjects with tension-type headache exhibit concomitant neck pain, cervical spine sensitivity, forward head posture, limited cervical range of motion, positive flexion-rotation test and also cervical motor control disturbances. In addition, the referred pain elicited by manual examination of the upper cervical joints and muscle trigger points reproduces the pain pattern in tension-type headache. Current data supports that the cervical spine can be also involved in tension-type headache, and not just in cervicogenic headache. Several physical therapies including upper cervical spine mobilization or manipulation, soft tissue interventions (including dry needling) and exercises targeting the cervical spine are proposed for managing tension-type headache; however, the effectiveness of these interventions depends on a proper clinical reasoning since not all will be equally effective for all individuals with tension-type headache. Based on current evidence, we propose to use the terms cervical "component" and cervical "source" when discussing about headache. In such a scenario, in cervicogenic headache the neck can be the cause (source) of the headache whereas in tension-type headache the neck will have a component on the pain pattern, but it will be not the cause since it is a primary headache.
几十年来，人们一直在讨论头痛可能起源于颈椎的概念，这仍然是一个争论的话题。颈椎一直与颈源性头痛有关；然而，目前的证据支持紧张型头痛也存在颈椎肌肉骨骼功能障碍。
本文讨论了关于紧张型头痛的颈椎的最新临床和循证数据。
紧张型头痛患者表现为同时存在颈部疼痛、颈椎敏感度、头部前倾、颈椎活动范围受限、屈伸旋转试验阳性，以及颈椎运动控制障碍。此外，对颈椎上关节和肌肉触发点进行手动检查引起的牵涉痛可重现紧张型头痛的疼痛模式。目前的数据支持颈椎不仅与颈源性头痛有关，也与紧张型头痛有关。几种物理治疗方法，包括颈椎上部关节活动度或推拿、软组织干预（包括干针）和针对颈椎的运动，被提议用于治疗紧张型头痛；然而，这些干预的有效性取决于适当的临床推理，因为并非所有方法对所有紧张型头痛患者都同样有效。基于目前的证据，我们建议在讨论头痛时使用“颈椎成分”和“颈椎来源”这两个术语。在这种情况下，颈源性头痛中，颈部可能是头痛的原因（来源），而在紧张型头痛中，颈部会对疼痛模式产生影响，但它不是原因，因为它是原发性头痛。
