Increased mechanosensivity of the greater occipital nerve in subjects with side-dominant head and neck pain – a diagnostic case-control study

ABSTRACT

Objectives: To investigate differences in pressure pain thresholds (PPTs) and longitudinal mechanosensitivity of the greater occipital nerve (GON) between patients with side-dominant head and neck pain (SDHNP) and healthy controls. Evaluation of neural sensitivity is not a standard procedure in the physical examination of headache patients but may influence treatment decisions.

Methods: Two blinded investigators evaluated PPTs on two different locations bilaterally over the GON as well as the occipitalis longsitting-slump (OLSS) in subjects with SDHNP (n = 38)) and healthy controls (n = 38).

Results: Pressure pain sensitivity of the GON was lower at the occiput in patients compared to controls (p = 0.001). Differences in pressure sensitivity of the GON at the nucheal line, or between the dominant headache side and the non-dominant side were not found (p > 0.05). The OLSS showed significant higher pain intensity in SDHNP (p < 0.001). In comparison to the non-dominant side, the dominant side was significantly more sensitive (p = 0.004).

Discussion: Palpation of the GON at the occiput and the OLSS may be potentially relevant tests in SDHNP. One explanation for an increased bilateral sensitivity may be sensitization mechanisms. Future research should investigate the efficacy of neurodynamic techniques directed at the GON.

Level of Evidence: 3b.

KEYWORDS:

• Greater occipital nerve
• mechanosensivity
• neurodynamic
• pressure pain threshold
• migraine
• cervicogenic headache

Acknowledgments

We thank the International Maitland Teacher Association (IMTA) for a supporting fund or realizing the logistic part of this study.

Disclosure statement

We certify that we do not have any conflicts of interest in the study.

Additional information

Funding

International Maitland Teacher Association within the Geoff Maitland Research Grant Foundation.

Notes on contributors

Tibor M. Szikszay

Tibor M. Szikszay is a physiotherapist earned his MSc in musculoskeletal Therapy on the University of Applied Science in Osnabrück and is currently doing his PhD at the University of Lübeck both in Germany focusing on chronic pain and endogenous pain modulation.

Kerstin Luedtke

Kerstin lüdke is Professor for physiotherapy at the University of Lübeck(Germany) with a research focus on the role of physiotherapy in the management of primary headaches.

Piekartz Harry von

Harry von Piekartz is Professor for Physical Therapy, course director of the MSc in musculoskeletal Therapy on the University of Applied Science in Osnabrück (Germany), clinician and researcher in head -face and neck pain.