A proposed etiology of cervicogenic headache: The neurophysiologic basis and anatomic relationship between the dura mater and the rectus posterior capitis minor muscle

Objective: To examine the neurophysiologic dura mater and the rectus capitis posterior minor muscle in the etiologic proposition of cervicogenic headache. Data Sources: On-line searches in MEDLINE and the Index to Chiropractic Literature, manual citation searches, and peer inquiries. Results: Connective tissue bridges were noted at the atlanto-occipital junction between the rectus capitis posterior minor muscle and the dorsal spinal dura. The perpendicular arrangement of these fibers appears to restrict dural movement toward the spinal cord. The ligamentum nuchae was found to be continuous with the posterior cervical spinal dura and the lateral portion of the occipital bone. Anatomic structures innervated by cervical nerves C1-C3 have the potential to cause headache pain. Included are the joint complexes of the upper 3 cervical segments, the dura mater, and spinal cord. Conclusion: A sizable body of clinical studies note the effect of manipulation on headache. These results support its effectiveness. The dura-muscular, dura-ligamentous connections in the upper cervical spine and occipital areas may provide anatomic and physiologic answers to the cause of the cervicogenic headache. This proposal would further explain manipulation's efficacy in the treatment of cervicogenic headache. Further studies in this area are warranted to better define the mechanisms of this anatomic relationship.