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Chiropractic Research Review

Migraine and Cervicogenic Headache Linked to Upper Cervical Spine

The ponticulus posticus of the atlas, foramen arcuale or "Kimmerle's anomaly"-a common variation of the atlas vertebra-has been associated with headaches, photophobia and migraine, though little epidemiologic evidence for these connections exists.

This study investigated the relationship of ponticulus posticus on x-ray studies and headache symptoms in 895 first-time chiropractic patients.

The complaints they presented included migraine with aura (classical migraine), migraine without aura (common migraine), cervicogenic headache, neck pain only and other complaints. They were examined for the presence or absence of partial or complete ponticulus posticus.

Eighteen percent of the patients in the study had ponticulus posticus. The results showed a significant correlation of PP with migraine without aura. The authors described several potential reasons for this relationship. Because the PP is intimately attached to the atlanto-occipital membrane and this membrane, in turn, is attached to the dura, small tensions exerted on the dura may result in excruciating head pain of a type experienced in migraine. The authors hold that "mechanical dysfunction at the atlanto-occipital joint (subluxation, articular lock, or minor instability) could result in traction on the dura, initiating the onset of unilateral headache so prevalent in migraine."

Conclusions: There seems to be a significant association between ponticulus posticus and migraine without aura. The authors feel that beneficial results of chiropractic treatment for migraine and cervicogenic headache are probably related to atlanto-occipital segmental structures.

Wight S, Osborne N, Breen AC. Incidence of ponticulus posterior of the atlas in migraine and cervicogenic headache. Journal of Manipulative and Physiological Therapeutics, Jan. 1999;22(1), pp15-20. Reprints: Tel: (800) 325-4177, ext 4350; Fax: (314) 432-1380

Chiropractic Research Review

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