When A Suboccipital Headache Lingers: Dig A Little Deeper

This blog will review a particularly helpful suboccipital nerve floss and provide some new information to help you differentiate suboccipital neuropathy from radiculopathy.

First, let’s check out this earlier video where Dr. Steele discusses the anatomic basis of cerviogenic headache and demonstrates a very useful suboccipital nerve floss to relieve cervicogenic headaches.

However, what if the nerve irritation is not a peripheral neuropathy, but rather a radiculopathy?

A recent article by Ko (2018) in the Asian Journal of Neurosurgery describes a compelling case that may offer additional options for stubborn cases.

“Here, we report a unique case of chronic temporo-occipital headache due to C3 radiculopathy — a 62-year-old male presented with a chronic left-sided temporo-occipital headache with a duration of 4 years. The headache was aching and pressure like in nature. It had a typical radiating pattern on every occasion. It started in the posterior temporal area above the ear. It then extended to retroauricular area, then suboccipital area, and lateral neck. No hypesthesia, allodynia, or limitation in neck motion was noted.

Myelographic CT revealed a left-sided C2/C3 foraminal stenosis. Subsequent foraminotomy and decompression of the left C3 completely alleviated the chronic left-sided temporo-occipital headache. The present case might be a typical example of “headache attributed to upper cervical radiculopathy” (A11.2.4) rather than cervicogenic headache according to the International Classification of Headache Disorders.” (4)

Although chiropractors may prefer to start with a less aggressive means of treatment, this paper by Ko reminds us that suboccipital pain may arise from within the IVF. Cervical spondylosis is a common age-related degenerative change, eventually triggering nerve root irritation and compression, resulting in head, neck, or upper extremity radicular signs and symptoms.  Neck stiffness is a common presenting complaint of cervical spondylosis; along with pain, paresthesia or numbness in the arm (99%), neck (80%), or shoulder & periscapular region (52%) (5). Suboccipital pain is also common, and headaches are present in 10-33% of cases (5,6).

Evidence-based chiropractors must spend the time to accurately identify and correct all of the variables associated with each diagnosis.

In practice, neurogenic symptoms typically arise from multiple sources of irritation or compression, including degeneration, posture, hypertonic muscles, habits, hobbies, and sports.  For example, Carpal Tunnel Syndrome may result from cumulative compression of the median nerve fibers at the intervertebral foramen, scalenes, pronator teres, and carpal tunnel. However, if we ride by on a fast horse and forget about the patient’s posture, job requirements, and sleep positions, we may not be treating all of the pertinent factors.  Lasting resolution of symptoms requires addressing all of the variables responsible for a condition’s etiology.


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