Painful Intervertebral Dysfunction: Robert Maigne's Original Contribution to Headache of Cervical Origin


Jacques P. Meloche, M.D., 1575 Henri-Bourassa West, Suite 330, Montreal,Quebec, Canada, H3M 3A9



Professor Robert Maigne, a French Orthopedic Medicine and Functional Rehabilitation specialist, hasput forward new concepts leading to a better understanding of common pain of spinal origin. Maigneexplains that pain in the spine is due to an intervertebral dysfunction of the mobile segment which consistsof the intervertebral disc, ligaments and the facet joints. Any benign mechanical dysfunction of the mobilesegment can induce a pain radiating in the dermatome at the same level as the vertebral problem. Maignealso described signs found in the skin (cellulalgia), in the muscles (myalgic bands) and in the bonyinsertions of tendons (tenalgia). These signs are to be found in the same dermatome, myotome andsclerotome as the spinal dysfunction. For headache of cervical origin due to painful intervertebraldysfunction, the most frequent dysfunctional mobile segment is located at the C2-C3 level. This inducespain mostly in the posterior parts of the head and cellulalgia in the C2 and C3 dermatomes. Painfultumefaction is also found over the posterior aspects of the facet joints on palpation at this level. Thesefindings are key elements for the diagnosis of painful intervertebral dysfunction. The recognition of thesesigns is changing our understanding of the role of the cervical spine in headaches. Painful intervertebraldysfunction is very frequently found in chronic daily headaches.