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technique MYOSKELETAL ALIGNMENT TECHNIQUES Stomach-Sleepers' Headache Treating Suboccipitals and Dural Drag By Erik Dalton 102 m a s s a g e & b o d y w o r k n o v e m b e r / d e c e m b e r 2 0 1 5 The obliquus capitis inferior (OCI) muscles may be the most underappreciated of all the suboccipitals. Arising from the spinous process of C2 (axis) and inserting on the transverse process of C1 (atlas), their primary function is head-on-neck rotation. Notice in Image 1 how the hypercontracted right OCI causes reciprocal lengthening on the left. During intake exams, habitual stomach sleepers often recount waking one morning unable to turn the head left without triggering upper neck and head pain. Many of these stomach-sleeping headaches are rooted in neurovascular tension or compression from mechanical strain. In this article, I'll present cervicogenic headache research, propose biomechanical explanations, and demonstrate Myoskeletal Alignment Techniques (MAT) for treating stomach-sleepers' headaches. One of the first to focus on cervicogenic head pain was famed spine researcher Nikolai Bogduk, MD, PhD. In his 1995 paper "Anatomy and Physiology of Headache," Bogduk writes: "All headaches have common anatomy and physiology. All headaches are mediated by the trigeminocervical nucleus and are initiated by noxious stimulation of the endings of the nerves that synapse on this nucleus." 1 Bogduk explains that head pain arises from overstretched and compressed upper cervical spine dura and nerve roots (Image 2). In a 2011 study published in the journal Spine, Frank Scali and colleagues state that optimal suboccipital balance prevents abnormal dural tension during atlas-axis rotation and occipitoatlantal flexion and extension. 2 Interestingly, in 86 percent of the study's dissected cadavers, OCI fibers penetrated the C1–2 interspace and attached to the dural membrane. The obliquus capitis inferior (OCI) muscle overstretched on the left and locked short on the right. ©Blassen Medical. 1 2 3 Head pain arises from compressed upper cervical dura, which feeds the trigeminal nucleus. ©CCND, Winnipeg. An atlas wedge develops as a chronic OCI spasm fixates the right-rotated C1 on C2. ©Lippincott Williams & Wilkins.