Linear Headache - A Manifestation Of Cervicogenic Headache?
Michael Kinney, Craigavon Area Hospital, Southern HSC Trust.
17 September 2014
Dear Sir,
Linear headache: a recurrent unilateral head pain circumscribed in a line-shaped area.
Wang et al Journal of Headache and Pain 2014,15:45
With great interest, we read Wang et als’ description of a potentially novel headache phenotype called ‘Linear Headache’ (1). However, we would suggest that this pattern of headache is already known, and may be a pain referred from the upper cervical spine. Cooper et al describe maps of pain relieved following facet (zygapophysial) joint anaesthesia. In figure 4 of Cooper et al’s paper a linear territory of pain is attributed to c2/3 facet joints (2).
If patients with Linear Headache actually have upper cervical facet joint disease, then there is the potential to offer treatment either with manual techniques (3) or in refractory cases facet joint neurolysis (4, 5).
It would be interesting to know if patients with Linear Headache (or Epicrania Fugax) have a history of trauma, or spinal disease that would predispose them to a C1/2 or c2/3 facet joint syndrome, and whether manual neck assessments such as Passive Accessory Intervertebral Movements (PAIVMS)(6) or Flexion-Rotation Tests (7) would show clinical evidence of upper cervical involvement.
As a consequence of reading Cooper’s paper we had considered that patients describing a line of pain through the head were most likely experiencing facet joint pain, and were therefore manifesting a cervicogenic headache syndrome. Our own observations do not completely disprove the possibility that Linear Headache is a distinct entity. Nonetheless we feel that Cooper et als observation should be considered as a potential explanation for Linear Headaches before we add another syndrome to the International Headache Classification.
Yours faithfully
Dr Raeburn B. Forbes MD(Hons) FRCP Ed FRCP Lond Consultant Neurologist
Dr Michael Kinney MBChB MRCP Specialty Registrar in Neurology
Craigavon Area Hospital Southern HSC Trust County Armagh Northern Ireland UK BT63 5QQ
References:
1. Wang Y, Tian MM, Wang XH, Zhu XQ, Liu Y, Lu YN, et al. Linear headache: a recurrent unilateral head pain circumscribed in a line-shaped area. J Headache Pain. 2014;15:45. 2. Cooper G, Bailey B, Bogduk N. Cervical zygapophysial joint pain maps. Pain Med. 2007;8(4):344-53. 3. Jull G, Trott P, Potter H, Zito G, Niere K, Shirley D, et al. A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine (Phila Pa 1976). 2002;27(17):1835 43;discussion 43. 4. Govind J, King W, Bailey B, Bogduk N. Radiofrequency neurotomy for the treatment of third occipital headache. J Neurol Neurosurg Psychiatry. 2003;74(1):88-93. 5. Lord SM, Barnsley L, Wallis BJ, McDonald GJ, Bogduk N. Percutaneous radio-frequency neurotomy for chronic cervical zygapophyseal-joint pain. N Engl J Med. 1996;335(23):1721-6. 6. Jull G, Bogduk N, Marsland A. The accuracy of manual diagnosis for cervical zygapophysial joint pain syndromes. Med J Aust. 1988;148(5):233-6. 7. Hall TM, Briffa K, Hopper D, Robinson K. Comparative analysis and diagnostic accuracy of the cervical flexion-rotation test. J Headache Pain. 2010;11(5):391-7.
Linear Headache - A Manifestation Of Cervicogenic Headache?
17 September 2014
Dear Sir,
Linear headache: a recurrent unilateral head pain circumscribed in a line-shaped area.
Wang et al Journal of Headache and Pain 2014,15:45
With great interest, we read Wang et als’ description of a potentially novel headache phenotype called ‘Linear Headache’ (1). However, we would suggest that this pattern of headache is already known, and may be a pain referred from the upper cervical spine. Cooper et al describe maps of pain relieved following facet (zygapophysial) joint anaesthesia. In figure 4 of Cooper et al’s paper a linear territory of pain is attributed to c2/3 facet joints (2).
If patients with Linear Headache actually have upper cervical facet joint disease, then there is the potential to offer treatment either with manual techniques (3) or in refractory cases facet joint neurolysis (4, 5).
It would be interesting to know if patients with Linear Headache (or Epicrania Fugax) have a history of trauma, or spinal disease that would predispose them to a C1/2 or c2/3 facet joint syndrome, and whether manual neck assessments such as Passive Accessory Intervertebral Movements (PAIVMS)(6) or Flexion-Rotation Tests (7) would show clinical evidence of upper cervical involvement.
As a consequence of reading Cooper’s paper we had considered that patients describing a line of pain through the head were most likely experiencing facet joint pain, and were therefore manifesting a cervicogenic headache syndrome. Our own observations do not completely disprove the possibility that Linear Headache is a distinct entity. Nonetheless we feel that Cooper et als observation should be considered as a potential explanation for Linear Headaches before we add another syndrome to the International Headache Classification.
Yours faithfully
Dr Raeburn B. Forbes MD(Hons) FRCP Ed FRCP Lond
Consultant Neurologist
Dr Michael Kinney MBChB MRCP
Specialty Registrar in Neurology
Craigavon Area Hospital
Southern HSC Trust
County Armagh
Northern Ireland UK
BT63 5QQ
References:
1. Wang Y, Tian MM, Wang XH, Zhu XQ, Liu Y, Lu YN, et al. Linear headache: a recurrent unilateral head pain circumscribed in a line-shaped area. J Headache Pain. 2014;15:45.
2. Cooper G, Bailey B, Bogduk N. Cervical zygapophysial joint pain maps. Pain Med. 2007;8(4):344-53.
3. Jull G, Trott P, Potter H, Zito G, Niere K, Shirley D, et al. A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine (Phila Pa 1976). 2002;27(17):1835 43;discussion 43.
4. Govind J, King W, Bailey B, Bogduk N. Radiofrequency neurotomy for the treatment of third occipital headache. J Neurol Neurosurg Psychiatry. 2003;74(1):88-93.
5. Lord SM, Barnsley L, Wallis BJ, McDonald GJ, Bogduk N. Percutaneous radio-frequency neurotomy for chronic cervical zygapophyseal-joint pain. N Engl J Med. 1996;335(23):1721-6.
6. Jull G, Bogduk N, Marsland A. The accuracy of manual diagnosis for cervical zygapophysial joint pain syndromes. Med J Aust. 1988;148(5):233-6.
7. Hall TM, Briffa K, Hopper D, Robinson K. Comparative analysis and diagnostic accuracy of the cervical flexion-rotation test. J Headache Pain. 2010;11(5):391-7.
Competing interests
No Competing Interests.