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Observational Study
. 2023 Apr;31(2):124-129.
doi: 10.1080/10669817.2022.2122370. Epub 2022 Sep 14.

Sub-occipital muscle pressure pain thresholds correlate to direction of symptomatic active comfortable sustained neck rotation testing in post-concussive headache: a retrospective observational cross-sectional study

Matt H Hammerle  1 , Lucy C Thomas  2 , Alicia A Swan  3 , Lisa H Lu  4 , Julia M Treleaven  2
Affiliations
Observational Study

Sub-occipital muscle pressure pain thresholds correlate to direction of symptomatic active comfortable sustained neck rotation testing in post-concussive headache: a retrospective observational cross-sectional study

Matt H Hammerle et al. J Man Manip Ther. 2023 Apr.

Abstract

Objectives: To compare sub-occipital muscle pressure sub pain thresholds (PPTs) in individuals with persistent-post-traumatic-headache (PPTH) in relation to the presence or not of cranial nerve and/or autonomic symptoms reported during sustained neck rotation (SNR).

Background: Previously 81% of military service members with PPTH demonstrated symptoms with SNR up to 60 seconds. Of these, 54% reported symptoms in one (Uni-Symp) and 46% in both directions of rotation (Bi-Symp). Sub-occipital PPTs, in relation to SNR direction, were of interest.

Methods: Retrospective review of records of 77 individuals, with PPTH with both SNR and PPTs. Average suboccipital and scalene PPTs were compared between Asymptomatic (n = 13), upon SNR testing, or Symptomatic (Uni-Symp, n = 32, Bi-Symp, n = 32), groups.

Results: The Bi-Symp group had significantly reduced sub-occipital PPTs relative to the Asymptomatic group on both sides [p < 0.009] with no side-to-side differences in either group. The Uni-Symp group had significantly lower sub-occipital PPTs on the symptomatic SNR test direction compared to the asymptomatic side [t(31) = 3.37, p = 0.002]. There were no differences within or between groups in the scalene PPTs(p's > 0.08).

Conclusions: An upper cervical mechanical trigger of symptoms during SNR tests in some individuals with PPTH is possible. The direction of symptomatic SNR tests may indicate direction of guarded hypermobile dysfunction and direct treatment.

Keywords: Concussion; cervical spine; cervicalgia; headache; migraine; mild traumatic brain injury; persistent post-traumatic headache; sustained neck rotation test.

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Conflict of interest statement

No potential conflict of interest was reported by the authors. The views expressed herein are those of the author and do not reflect the official policy or position of Brooke Army Medical Center, the U.S. Army Medical Department, the U.S. Army Office of the Surgeon General, the Department of the Army, the Department of the Air Force, or the Department of Defense of the U.S. Government.

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Figures

Figure 1.
Figure 1.
Flow chart demonstrating selection of the study groups.
See this image and copyright information in PMC

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