Magnetic Resonance Imaging Study of The Morphometry of Cervical Extensor Muscles in Chronic Tension-Type Headache

Abstract

This study analyses the differences in the relative cross-sectional area (rCSA) of several cervical extensor muscles, assessed by magnetic resonance imaging (MRI), between patients with chronic tension-type headache (CTTH) and healthy controls. MRI of the cervical spine was performed on 15 CTTH females and 15 matched controls. The rCSA values for the rectus capitis posterior minor (RCPmin), rectus capitis posterior major (RCPmaj), semispinalis capitis and splenius capitis muscles were measured from axial T1-weighted images using axial MR slices aligned parallel to the C2/3 intervertebral disc. A headache diary was kept for 4 weeks in order to substantiate the diagnosis and record the pain history. CTTH patients showed reduced rCSA for both RCPmin and RCPmaj muscles (P < 0.01), but not for semispinalis and splenius capitis muscles, compared with controls. Headache intensity, duration or frequency and rCSA in both RCPmin and RCPmaj muscles were negatively correlated (P < 0.05): the greater the headache intensity, duration or frequency, the smaller the rCSA in the RCPmin and RCPmaj muscles. CTTH patients demonstrate muscle atrophy of the rectus capitis posterior muscles. Whether this selective muscle atrophy is a primary or secondary phenomenon remains unclear. In any case, muscle atrophy could possibly account for a reduction of proprioceptive output from these muscles, and thus contribute to the perpetuation of pain.

Anatomical Parameters of the Rectus Capitis Posterior Minor Muscle Based on a New Magnetic Resonance Scan Method

“…It is hypothesized to perform some physiological functions, such as protecting the spinal cord from dural enfolding (Hack et al;Pontell et al;Chang et al;Fernández-de-Las-Peñas et al, 2008;McPartland et al), placing tension to the dura under (Rutten et al, 1997;Chang et al;Fernández-de-Las-Peñas et al, 2008;McPartland et al), maintaining the integrity of the subarachnoid space (Fernández-de-Las-Peñas et al, 2008;McPartland et al), and working as a pump via the MDBs to provide power for CSF circulation (Su et al; Zheng et al; Yuan et al). Furthermore, Some clinical studies found that the pathology of RCPmi for instance atrophy or swelling, might be closely related to chronic cervical headaches (McPartland et al;Alix & Bates;Fernández-de-Las-Peñas et al, 2007;Fernández-de-Las-Peñas et al, 2008).…”

“…In the past 20 years, it was proposed that through the MDBs the RCPmi might perform some physiological functions, like protecting the spinal cord from dural enfolding (Chang et al, 1992;Hack et al;McPartland et al, 1997;Fernández-de-Las-Peñas et al, 2008;Pontell et al), placing tension to the dura under (Chang et al;McPartland et al;Rutten et al, 1997;Fernández-de-Las-Peñas et al, 2008;), maintaining the integrity of the subarachnoid space (McPartland et al;Fernández-de-Las-Peñas et al, 2008), and working as a pump via the MDBs to provide power for CSF circulation (Su et al;Zheng et al;Yuan et al, 2016). Furthermore, Some clinical studies found that the pathology of the suboccipital muscles, for instance atrophy or swelling of the RCPmi, might be closely related to chronic cervical headaches (McPartland et al;Alix & Bates, 1999;Fernández-de-Las-Peñas et al, 2007;Fernández-de-Las-Peñas et al, 2008). Although the RCPmi has been studied with emphasis on their physiological and pathological significance, there is a paucity of data in the imaging anatomical parameters of this muscles.…”

Effect of the Suboccipital Musculature on Symptom Severity and Recovery after Mild Traumatic Brain Injury

“…24 Most interesting, decreased cross-sectional area in the rectus capitis-PMaj and rectus capitis-PMin musculature has also been found in patients with chronic tension-type headaches, in which the lower cross-sectional areas of the rectus capitis-PMaj and rectus capitis-PMin were associated with greater headache intensity, duration, and frequency. 25 Tension-type headaches are among the most common headaches experienced after mTBI, with almost 40% of postconcussive headaches reported as tension headaches. 26 However, the role of the rectus capitisPMaj and rectus capitis-PMin in mTBI and their association with posttraumatic headaches have not been investigated, to our knowledge.…”

Bilateral Asymmetry of Semispinalis Capitis Muscle Thickness and Neck Motion during Prone Neck Extension in Subjects with Unilateral Posterior Neck Pain

“…Therefore, ultrasonography is valid for measuring the thickness, but not the width or crosssectional area, of the cervical multifidus and semispinalis capitis muscles 12,13) . Previous studies have demonstrated that bilateral symmetry is seen in ultrasound images of the posterior neck muscles of healthy subjects and patients with bilateral neck pain 7,11) .…”

“…The size of the cervical paraspinal muscles is measured when evaluating muscle function and provides a basis for therapeutic interventions in patients with chronic neck pain [6][7][8] . Measuring the size of the cervical paraspinal muscles is considered an objective method of estimating indirect strength [9][10][11] .…”