In the onset of headaches, the trigeminal nerve plays a central role. Its original nucleus descends along the spinal cord opposite the second and third cervical vertebrae C2 and C3. It innervates three quarters of the face, certain blood vessels in the brain and the meninges.
Muscle contractures often causing irritation of the trigeminal nerve
When this nerve is irritated at its roots, where it emerges between two vertebrae, a pain signal is transmitted along its path. “Irritation on the second cervical nerve will trigger pain aimed at the forehead, temples, eye and jaw. Irritation on the third nerve will result in pain on the occiput or the top of the skull, ”explains Dr Norbert Teisseire, rheumatologist and member of the French Society of Orthopedic and Osteopathic Manual Medicine (SOFMMOO). This mechanism is common to most classic headaches, such as tension headaches, some migraines, the cluster headaches or even the Arnold’s neuralgia.
Spinal dysfunctions that irritate the nerve roots are often caused by bad postures (at work, on the operating table during surgery, etc.),osteoarthritis, a “whiplash” at the time of an accident car crash or head shock. “By examining the base of the skull and the neck, we will find characteristic muscle contractures which correspond to the C2 and C3 vertebrae at 95%”, specifies Dr Teisseire. But, of course, you have to check that this headache does not hide a more serious underlying problem, such as a brain tumor or vascular disease.
Osteopathy helps reduce pain medication
Osteopathy can relieve headache simple and even help reduce consumption of pain medication.
The professional’s actions on the skull and neck will “improve brain drainage, lower pressure and release tension,” says Michel Sala, president of the French Osteopathy Association. But, he may also have to work on other areas, for example the diaphragm. “Tensions in this muscle can go up to the muscles of the neck also involved in breathing”, observes Thibault Dubois, spokesperson for the French Syndicate of Osteopaths.
It is effective in two sessions for chronic headaches
The SOFMMOO estimates that “cervical treatment is useful for 80% of chronic headaches associated with minor intervertebral disturbance C2-C3”. In principle, two sessions are sufficient to resolve the bulk of the problem. “In the presence of cervical signs, we work delicately, assures Dr. Teisseire.
- During the first session, the reactivity of the person is tested by muscle preparation and gentle mobilization.
- Ten days later, during the second session, we treat with other manipulations. The results must be fast. “
If the patient does not get better after two sessions, the diagnosis must be called into question. If the improvement is rapid in the case of tension headaches, Thibault Dubois recognizes that it is longer and more difficult to obtain for certain migraines.
“The pathophysiology of migraine is very complicated and is still the subject of research. An osteopath cannot claim to cure it. Nevertheless, we can relieve muscle tension. This will lower the pain trigger threshold and significantly reduce the frequency and intensity of seizures, ”he concludes.
Two precautions before any cervical manipulation
Manipulating the cervicals is not trivial. The practice is seriously supervised.
- Obtain medical advice. Since 2007, a decree has governed osteopathy when it is practiced by people who are not doctors. This text establishes theobligation of a medical opinion before any manipulation of the cervical spine. “The manipulation is a unique and rapid maneuver, at the limits of the physiological play of the vertebra and which can cause a cracking noise. It can be used for certain headaches. But the rule is rather to practice cervical mobilizations, repeated gestures with more amplitude, ”explains Thibault Dubois. This medical opinion makes it possible to verify that there is no risk of dissection of one of the vertebral arteries supplying the brain.
“We do not handle people who have fragile arteries, for example those who suffer from atherosclerosis (arteries blocked by atheroma plaques, Editor’s note), or even young women who smoke on pills”, insists Thibault Dubois who quotes the figure of one accident for 7 million manipulations.
- Perform an x-ray. Doctors practicing osteopathy require a cervical x-ray before working on the patient. “The latter makes it possible to eliminate a bone pathology, malformation, even neurological”, explains thus
Dr Norbert Teisseire. In non-medical osteopaths, this examination is not requested systematically. Michel Sala believes, however, that it is “compulsory in the event of trauma”.