Lateralization of headache: possible role of an upper cervical trigger point.

An ipsilateral upper neck trigger point was found in 21 of 24 patients with unilateral headache. During the prodromic period this trigger point was detected as a tender protrusion on neck palpation. In 18 out of 24 patients it was also found during the headache-free period. On standard roentgenogram, this protrusion seemed to be a laterally developed C2 spinous process. The EMG study showed latent trapezius hypertonicity on the side of the headache, even during the headache-free period. The association of the painful protrusion and trapezius hypertonicity could create an autoreinforcing nociceptive loop, which in turn could be the cause of lateralization of the pain.