Spinal Posture-Induced Episodic Headaches: A New Paradigm – Clinical Pain Advisor

By | May 23, 2019

Maladaptive postures may trigger episodic headaches, according to a literature review published in Current Pain and Headache Reports.1

Researchers reviewed the literature to examine data supporting the paradigm that spinal posture may trigger episodic headaches, “based on a multi-dimensional view on tension-type and cervicogenic headache.”

“Little is known about the contribution of the spinal sitting posture to the headache process,” according to the review’s lead author, Sarah Mingels, PhD, from the Rehabilitation Research Centre, Biomedical Research Institute, Faculty of Rehabilitation Sciences at Hasselt University in Belgium. “Although we can only give advice based on a thorough review of the literature…within our view, patients with spinal posture-induced episodic headache might be profiled based on a mixture of spinal posture characteristics and specific psychosocial, cognitive, and lifestyle factors. A clinical examination should therefore include appropriate tests to evaluable each variable,” she told Clinical Pain Advisor.

The Effect of a Contemporary Lifestyle

“Headache disorders are one of the most common disorders of the nervous system, and they can cause substantial personal suffering and impair one’s quality of life, as not only the repeated attacks but also the constant fear of the next one can have a disabling effect,” noted Dr Mingels. “On a global scale, headaches are ranked as the third highest cause of year lost due to disability, yet despite all of this, many people, healthcare professionals included, tend to perceive it as a trivial complaint.”

Dr Mingels and colleagues hypothesized that spinal posture could act as a trigger for headache, which prompted them to conduct a literature review. “We introduced a new terminology, with the term ‘spinal postured-induced episodic headache,’ ” said Dr Mingels. Review authors emphasize the fact that primary headaches are frequently idiopathic, and that in many cases, diagnosis is reached by exclusion, in contrast with secondary headaches, that have been associated with a wide array of etiologies.2

Primary and some secondary headaches are heterogeneous in nature, arising from “complex, multi-dimensional interactions between biological, psychosocial, cognitive, lifestyle and environmental factors,” the authors wrote. As different triggers may lead to comparable sets of symptoms, identifying the mechanisms underlying headache may prove challenging.

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“We already know that maladaptive cervical postures seem a dominant trigger in both tension-type and cervicogenic headaches, yet treatment outcomes vary,” Dr Mingels said. “We therefore need to pay more attention to lifestyle and other contextual factors in the evaluation of headache. Our contemporary lifestyle, with its technological expansion, has reduced levels of physical activity and increased sedentary behavior, a lifestyle which influences our habitual sitting behavior in such a way that neuromuscular complaints such as episodic headache could arise.”

This is the first review examining the relationship between habitual spinal sitting posture and episodic headache.

Biomechanical Pathway

A higher prevalence of musculoskeletal complaints (eg, upper extremity, neck, and head pain) has been associated with computer use for more than 3 hours daily, presumably related to increased habitual slumped position while using computers.3 Patients with tension-type and cervicogenic headaches may have postural deviations. A slumped seated position with forward head position may cause stress, activating peripheral cervical nociceptors. Putative headache cervical pain generators are innervated by C1-C3 afferent spinal nerves.

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