As an ENT specialist and manual medicine practitioner (retired), I have frequently seen children and adolescents with headache who were referred to me to exclude an underlying ENT condition. In most cases, a cervical syndrome was present, i.e. a functional block of the craniovertebral joints (phenomenon of the jammed drawer) (1–4). In most cases, the treatment success was surprising for the parents. Unfortunately, not many health professionals are aware of the fact that children can have cervical syndromes too. Cervical syndromes are rarely diagnosed because
- children seldom complain about occipital headache
- no laboratory findings can verify this diagnosis
- radiography shows no abnormalities in the absence of osteoarthritic changes of the cervical spine
- the condition can only be diagnoses based on the manual palpation findings and the treatment success (“ex juvantibus”).
However, in their paper the authors provide very important medical history information indicative of cervical syndrome (5):
- back pain
- neck / shoulder pain
- dizziness (cervical vertigo)
- little physical exercise
In almost all patients with cervical syndrome, one side is more affected than the other because facet joints are paired joints. Consequently, one-sided complaints are strongly indicative of an underlying cervical problem. The one-sided block of paired facet joints is the only sensible explanation for one-sided and same-sided headache. The medical literature offers no other plausible explanation for one-sided chronic, recurrent headache.
Of course, there are other physical and psychological causes overlapping and modifying a cervical syndrome and therefore all the different diagnostic and therapeutic approaches have their value. But when no attention is paid to the cervicocranial joints in the diagnosis and treatment of headache in children, including school children, therapy will certainly go the wrong way.
Dr. med. Hans Alex Falkenau
|1.||Falkenau HA: Das Zervikalsyndrom des Kindes in der Hals-Nasen-Ohrenheilkunde. HNO 1978; 26: 384–5. MEDLINE|
|2.||Graf M: Manuelle Diagnostik und Therapie im Kopfgelenksbereich. Manuelle Medizin 2007; 45: 232–41.|
|3.||Frese A, Schilgen M, et al.: Pathophysiologie und Klinik zervikogener Kopfschmerzen. Der Schmerz 2003; 17: 125–30. MEDLINE|
|4.||Lohse-Busch H: Manuelle Medizin bei kindlichen muskuloskelettalen Schmerzen. Manuelle Medizin 2002; 40: 32–40.|
|5.||Straube A, Heinen F, Ebinger F, von Kries R: Headache in school children: prevalence and risk factors. Dtsch Arztebl Int 2013; 110: 811–8. VOLLTEXT|