What do the alar ligaments have to do with headaches?

Alar LigamentsDeep within the array of upper cervical (upper neck) ligaments are found a pair of fine ligaments known as alar ligaments.  All through the body ligaments play an important role in maintaining the integrity and function of a joints.

A study utilizing a special MRI protocol has now found a link between the alar ligaments within the upper cervical spine and chronic neck pain and headaches in elderly patients who report that they had been involved in a whiplash-type event.

134 elderly patients with headaches, neck pain, and a history of sustaining a whiplash event were given a medical examination which included a high resolution proton density weighted 3.0 Tesla MRI imaging.  Radiologists diagnosed chronic alar ligament injury when they visualized abnormally high signals on MRI in the ligamentous body or vicinity of the occipital condyle involving the ligament’s edge in varying degrees, or adjacent side subdural effusion of cerebrospinal fluid.  MRI Results:  28 of the 134 elderly patients demonstrated evidence of positive chronic alar ligament injury; 12 had cerebrospinal fluid leakage findings.   It is known that alar ligament degenerative changes primarily occur at the edges of the ligament (the same area typically damaged in a whiplash event, but in this study 5 of the participants also had abnormal MRI signals located in the body of the ligament.

Many of the other study participants (89) had MRI findings of intervertebral disc protrusion, spinal disease, RA, moderate to severe cervical degenerative disease, tumor, or Spondylitis.

Note:  Typically MRIs for spinal and musculoskeletal assessments are conducted with a 1.5 Tesla magnet.  With this study the use of a higher intensity 3.0 Tesla magnet allowed for increased visualization of certain anatomical structures that were not as visible with the 1.5 Tesla MRI.

Source:  MR investigation in evaluation of chronic whiplash alar ligament injury in elderly patients.  Journal of Central South University; Medical Science 2015; Vol. 40; No. 1; pp. 67-71.


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