Painful intervertebral dysfunction: Robert Maigne's original contribution to headache of cervical origin. The Quebec Headache Study Group

Professor Robert Maigne, a French Orthopedic Medicine and Functional Rehabilitation specialist, has put forward new concepts leading to a better understanding of common pain of spinal origin. Maigne explains that pain in the spine is due to an intervertebral dysfunction of the mobile segment which consists of the intervertebral disc, ligaments and the facet joints. Any benign mechanical dysfunction of the mobile segment 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 insertions of tendons (tenalgia). These signs are to be found in the same dermatome, myotome and sclerotome as the spinal dysfunction. For headache of cervical origin due to painful intervertebral dysfunction, the most frequent dysfunctional mobile segment is located at the C2-C3 level. This induces pain mostly in the posterior parts of the head and cellulalgia in the C2 and C3 dermatomes. Painful tumefaction is also found over the posterior aspects of the facet joints on palpation at this level. These findings are key elements for the diagnosis of painful intervertebral dysfunction. The recognition of these signs is changing our understanding of the role of the cervical spine in headaches. Painful intervertebral dysfunction is very frequently found in chronic daily headaches.