PAINFUL INTERVERTEBRAL DYSFUNCTION - MAIGNE,ROBERT ORIGINAL CONTRIBUTION TO HEADACHE OF CERVICAL ORIGIN

Professor Robert Maigne, a French Orthopedic Medicine and Functional R ehabilitation specialist, has put forward new concepts leading to a be tter understanding of common pain of spinal origin. Maigne explains th at pain in the spine is due to an intervertebral dysfunction of the mo bile segment which consists of the intervertebral disc, ligaments and the facet joints. Any benign mechanical dysfunction of the mobile segm ent can induce a pain radiating in the dermatome at the same level as the vertebral problem. Maigne also described signs found in the skin ( cellulalgia), in the muscles (myalgic bands) and in the bony insertion s of tendons (tenalgia). These signs are to be found in the same derma tome, myotome and sclerotome as the spinal dysfunction. For headache o f cervical origin due to painful intervertebral dysfunction, the most frequent dysfunctional mobile segment is located at the C2-C3 level. T his induces pain mostly in the posterior parts of the head and cellula lgia in the C2 and C3 dermatomes. Painful tumefaction is also found ov er the posterior aspects of the facet joints on palpation at this leve l. These findings are key elements for the diagnosis of painful interv ertebral dysfunction. The recognition of these signs is changing our u nderstanding of the role of the cervical spine in headaches. Painful i ntervertebral dysfunction is very frequently found in chronic daily he adaches.