Cranial suture headache: An extracranial head pain syndrome originating in the cranial sutures of the skull (2022)

Abstract

Objective: To define a new type of head pain syndrome termed “cranial suture headache” which is a localized headache originating along the cranial suture lines of the skull. Background: Well localized headaches maybe extracranial in origin. As trigeminal nociceptors are localized within the cranial sutures of the skull, these fibrous joints maybe the source of head pain for some patients. Methods: Case series. To diagnose cranial suture headache, the patient’s pain had to be localized to the skull and elicited/mimicked by mild to moderate palpation over one or more distinct cranial suture lines. Results: Ten cases are presented. Most of the patients were women (9/10). The headache started daily from onset in all cases. Range of age of headache onset was 32–64 years. Headache was one sided, unless confined to the midline and typically lacked any migrainous and/or cranial autonomic symptoms. Most cranial suture headaches localized to either the sagittal, coronal or squamosal suture lines. Headache duration prior to diagnosis was on average 8.5 years. Triggering events: three began immediately after head trauma, two had very remote head trauma, one was post infectious, one was post craniotomy, while three patients had no known triggering event. All patients were treatment refractory failing at least three preventive medications. All improved with localized anesthetic injection to the suture line(s) and/or onabotulinum toxin A injection only to the cranial sutures. Discussion: Without the recognition of cranial suture-based pain, patients may have unremitting headaches that can last years to decades. The observation that “cranial suture” headache improves with localized treatment only to the cranial sutures would seem to suggest the extracranial origin of the pain.

Original languageEnglish (US)
JournalCephalalgia Reports
Volume4
DOIs
StatePublished - 2021

Keywords

  • chronic daily headache
  • cranial suture
  • extracranial
  • new daily persistent headache
  • trigeminal nerve

ASJC Scopus subject areas

  • Clinical Neurology

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Rozen, T. D. (2021). Cranial suture headache: An extracranial head pain syndrome originating in the cranial sutures of the skull. Cephalalgia Reports, 4. https://doi.org/10.1177/25158163211040072

Cranial suture headache : An extracranial head pain syndrome originating in the cranial sutures of the skull. / Rozen, Todd D.

In: Cephalalgia Reports, Vol. 4, 2021.

(Video) How to do a craniotomy

Research output: Contribution to journalArticlepeer-review

Rozen, TD 2021, 'Cranial suture headache: An extracranial head pain syndrome originating in the cranial sutures of the skull', Cephalalgia Reports, vol. 4. https://doi.org/10.1177/25158163211040072

Rozen TD. Cranial suture headache: An extracranial head pain syndrome originating in the cranial sutures of the skull. Cephalalgia Reports. 2021;4. https://doi.org/10.1177/25158163211040072

Rozen, Todd D. / Cranial suture headache : An extracranial head pain syndrome originating in the cranial sutures of the skull. In: Cephalalgia Reports. 2021 ; Vol. 4.

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(Video) Lecture 3.1 The Skull; Muscles of the Head and Neck

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(Video) Self Cranial Work at Home

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AB - Objective: To define a new type of head pain syndrome termed “cranial suture headache” which is a localized headache originating along the cranial suture lines of the skull. Background: Well localized headaches maybe extracranial in origin. As trigeminal nociceptors are localized within the cranial sutures of the skull, these fibrous joints maybe the source of head pain for some patients. Methods: Case series. To diagnose cranial suture headache, the patient’s pain had to be localized to the skull and elicited/mimicked by mild to moderate palpation over one or more distinct cranial suture lines. Results: Ten cases are presented. Most of the patients were women (9/10). The headache started daily from onset in all cases. Range of age of headache onset was 32–64 years. Headache was one sided, unless confined to the midline and typically lacked any migrainous and/or cranial autonomic symptoms. Most cranial suture headaches localized to either the sagittal, coronal or squamosal suture lines. Headache duration prior to diagnosis was on average 8.5 years. Triggering events: three began immediately after head trauma, two had very remote head trauma, one was post infectious, one was post craniotomy, while three patients had no known triggering event. All patients were treatment refractory failing at least three preventive medications. All improved with localized anesthetic injection to the suture line(s) and/or onabotulinum toxin A injection only to the cranial sutures. Discussion: Without the recognition of cranial suture-based pain, patients may have unremitting headaches that can last years to decades. The observation that “cranial suture” headache improves with localized treatment only to the cranial sutures would seem to suggest the extracranial origin of the pain.

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FAQs

What do cranial sutures do? ›

Joints made of strong, fibrous tissue (cranial sutures) hold the bones of your baby's skull together. The sutures meet at the fontanels, the soft spots on your baby's head. The sutures remain flexible during infancy, allowing the skull to expand as the brain grows. The largest fontanel is at the front (anterior).

Why do the sutures on my skull hurt? ›

Many of the pain fibers that navigate through the cranial sutures originate from dural nociceptor axons. Thus, cranial suture head pain is hypothesized to result from progressive irritation of these tiny trigeminal nociceptors within the cranial suture lines until they reach a threshold point to generate pain.

What are cranial sutures and how do they form? ›

Cranial sutures are fibrous bands of tissue that connect the bones of the skull. The sutures or anatomical lines where the bony plates of the skull join together can be easily felt in the newborn infant.

What are the 3 types of sutures? ›

Nylon. A natural monofilament suture. Polypropylene (Prolene). A synthetic monofilament suture.

How do you remember the skull sutures? ›

Sutures of the skull mnemonic - Kenhub #shorts - YouTube

Do adults have cranial sutures? ›

The cranial bones remain separate for about 12 to 18 months. They then grow together as part of normal growth. They stay connected throughout adulthood.

How many types of sutures are in the skull? ›

The main sutures of the skull are the coronal, sagittal, lambdoid and squamosal sutures.

What do headaches on top of your head mean? ›

Headaches that occur at the top of the head are typically a result of tension headaches, which are the most common. Associated with a dull pain, tightness or constant pressure around the head, they are triggered by things like a change in diet, poor sleeping habits, activity or stress.

What is an extracranial headache? ›

Extracranial headaches may be caused by dilation and distension of the extracranial arteries that supply the surface tissues of the head or sustained contraction of the skeletal muscles of the face, scalp, and neck. Excess fatigue, neck problems, and eyestrain can all cause extracranial headaches.

At what age do the cranial sutures close? ›

At birth, the sutures decrease in size (molding) and allow the skull to become smaller. In children, the suture enables the skull to expand with the rapidly growing brain. The suture will close and fuse around age 24.

Why are there sutures on the human skull What does this tell you about the actual structure? ›

The sutures are divisions between the bones on the skull. Early in life, these sutures allow for the growth of the skull and brain, and only later do they fuse together. This tells us that the skull is actually made up of several smaller bones, not one large bone.

What type of joint is skull suture? ›

Thus, skull sutures are functionally classified as a synarthrosis, although some sutures may allow for slight movements between the cranial bones.

Which cranial suture separates the frontal bone from the two parietal bones? ›

Coronal suture: the suture between the frontal bone and the two parietal bones.

What is the most common suture? ›

Simple interrupted suture: It is the most common and simple form of suturing technique. The suture is placed by inserting the needle perpendicular to the epidermis. Inserting it perpendicularly helps in a wider bite of deeper tissue to be included in the suture than at the surface leading to rapid wound healing.

What are the 2 types of sutures? ›

There are two varieties of sutures: absorbable and non-absorbable. Absorbable sutures do not require your doctor to remove them. The enzymes found in the tissues of your body will naturally digest them.

What is the difference between a suture and a stitch? ›

Although stitches and sutures are widely referred to as one and the same, in medical terms they are actually two different things. Sutures are the threads or strands used to close a wound. “Stitches” (stitching) refers to the actual process of closing the wound. However, “suturing” is often used to mean stitching.

What are the 22 bones of the skull? ›

The skull (22 bones) is divisible into two parts: (1) the cranium, which lodges and protects the brain, consists of eight bones (Occipital, Two Parietals, Frontal, Two Temporals, Sphenoidal, Ethmoidal) and the skeleton of the face, of fourteen (Two Nasals, Two Maxillae, Two Lacrimals, Two Zygomatics, Two Palatines, Two ...

What are the 4 Fontanelles? ›

Structure and Function
  • Anterior Fontanelle. The anterior fontanelle is the largest of the six fontanelles, and it resembles a diamond-shape ranging in size from 0.6 cm to 3.6 cm with a mean of 2.1 cm. ...
  • Posterior Fontanelle. ...
  • Mastoid Fontanelle. ...
  • Sphenoid Fontanelle. ...
  • Third Fontanel.
26 Jul 2021

Where are the sutures of the skull? ›

Sutures (L., sutura, from suere 'to sew') are junctions (or lines of articulation) between adjacent bones of the skull.

What are 8 cranial bones? ›

There are eight cranial bones, each with a unique shape:
  • Frontal bone. This is the flat bone that makes up your forehead. ...
  • Parietal bones. This a pair of flat bones located on either side of your head, behind the frontal bone.
  • Temporal bones. ...
  • Occipital bone. ...
  • Sphenoid bone. ...
  • Ethmoid bone.
24 May 2018

Do adults still have their skull sutures Why? ›

Full obliteration may never occur. The suture closes sometime between the ages of 30 years old and 40 years old. The suture has been seen to close normally at age 26 and also remain open until someone in their late 50's.

Where is the suture joint located? ›

A suture is a type of fibrous joint that is only found in the skull (cranial suture). The bones are bound together by Sharpey's fibres. A tiny amount of movement is permitted at sutures, which contributes to the compliance and elasticity of the skull. These joints are synarthroses.

Does skull shape affect brain? ›

Left untreated, the head shape will likely worsen but, more importantly, there is a risk for overall head growth restriction with development of increased pressure on the brain.

Can cranial sutures move? ›

If the sutures remain flexible throughout adulthood, some degree of motion is possible when driven by pressure changes in the craniosacral system. If the tissues fuse and become immobile, rhythmic motion is unlikely. Several studies have examined the nature of the cranial sutures.

Does the skull change shape with age? ›

Results demonstrate significant adult skull shape changes with increasing age. Shape changes were mostly notable within the inner cranial vault and the anterior and middle cranial fossae.

Why sutures are formed? ›

Sutures are formed during embryonic development at the sites of approximation of the membranous bones of the craniofacial skeleton. They serve as the major sites of bone expansion during postnatal craniofacial growth.

Can dirty hair cause headaches? ›

Your dirty hair could be causing headaches | Connect the Dots

What causes severe headache on the left side of the head? ›

A headache on the left side may result from migraine, vasculitis, cluster headaches, or other types. Often, a person can treat a headache at home with over-the-counter remedies and rest. However, if headaches are severe, persistent, or otherwise concerning, contact a healthcare professional.

What are extracranial structures? ›

These include extracranial structures such as the skin, muscles, and blood vessels in the head and neck; mucosa of the sinuses and dental structures; and intracranial structures including the regions of the large arteries near the circle of Willis, the great intracranial venous sinuses, parts of the dura and dural ...

What is an extracranial artery? ›

The term extracranial cerebral arteries refers to all of the arteries carrying blood up from the heart to the base of the skull. During a carotid ultrasound investigation, you will image and report on the extracranial cerebral arteries.

What is occipital neuralgia? ›

Occipital neuralgia is a distinct type of headache characterized by piercing, throbbing, or electric-shock-like chronic pain in the upper neck, back of the head, and behind the ears, usually on one side of the head.

What would happen if the skull sutures close prematurely? ›

When this occurs, the suture is said to “close.” In a baby with craniosynostosis, one or more of the sutures closes too early. This can limit or slow the growth of the baby's brain. When a suture closes and the skull bones join together too soon, the baby's head will stop growing in only that part of the skull.

Which cranial suture closes first? ›

In humans, the sequence of fontanelle closure is as follows: 1) posterior fontanelle generally closes 2-3 months after birth, 2) sphenoidal fontanelle is the next to close around 6 months after birth, 3) mastoid fontanelle closes next from 6-18 months after birth, and 4) the anterior fontanelle is generally the last to ...

What causes your skull to separate? ›

Diseases or conditions that cause an abnormal increase in the pressure within the head can cause the sutures to spread apart. These separated sutures can be a sign of pressure within the skull (increased intracranial pressure). Separated sutures may be associated with bulging fontanelles.

Why can I feel my coronal suture? ›

There are two coronal sutures, each running from the top of the head down the sides in front of the ears. When one of these sutures closes prematurely, the baby begins to develop flatness of the forehead on the affected side. A ridge over the affected suture may be felt through the scalp.

What are split sutures in newborn? ›

Separated sutures are abnormally wide spaces in the bony joints of the skull in an infant. The skull of an infant or young child is made up of bony plates that allow for growth.

When do overriding sutures disappear? ›

In an infant only a few minutes old, the pressure from delivery compresses the head. This makes the bony plates overlap at the sutures and creates a small ridge. This is normal in newborns. In the next few days, the head expands and the overlapping disappears.

What are the 3 joints in the skull? ›

There are three types of fibrous joints: sutures, syndesmoses, and gomphoses. Sutures are found only in the skull and possess short fibers of connective tissue that hold the skull bones tightly in place (Figure 19.23).

Which type of joint includes the sutures of the skull quizlet? ›

Thus fibrous joints, such as sutures in the skull, are examples of synarthrosis joints.

What are skull sutures made of? ›

Joints made of strong, fibrous tissue (cranial sutures) hold the bones of your baby's skull together. The sutures meet at the fontanels, the soft spots on your baby's head. The sutures remain flexible during infancy, allowing the skull to expand as the brain grows.

Can You Feel skull sutures? ›

Feeling the cranial sutures and fontanelles is one way that health care providers follow the child's growth and development. They are able to assess the pressure inside the brain by feeling the tension of the fontanelles. The fontanelles should feel flat and firm.

Which are the four major cranial sutures and between which bones are they found? ›

There are four major sutures that connect the bones of the cranium together: the frontal or coronal, the sagittal, the lambdoid, and the squamous. The frontal suture connects the frontal bone to the two parietal bones. The sagittal suture connects the two parietal bones.

What type of bone is parietal bone? ›

The parietal bone is a paired, irregular, quadrilateral skull bone that forms the sides and roof of the cranium.

How many types of sutures are in the skull? ›

The main sutures of the skull are the coronal, sagittal, lambdoid and squamosal sutures.

How many types of sutures are there? ›

There are two varieties of sutures: absorbable and non-absorbable.

How do you remember the skull sutures? ›

Sutures of the skull mnemonic - Kenhub #shorts - YouTube

How many sutures are there on a human skull name each suture? ›

More videos on YouTube

The sutures are a type of fibrous joint, found in between many of the bones that make up the skull. Today we're going to take a look at three sutures; the coronal suture, the sagittal suture and the lambdoid suture.

What type of joint is skull suture? ›

Thus, skull sutures are functionally classified as a synarthrosis, although some sutures may allow for slight movements between the cranial bones.

Do adults still have their skull sutures Why? ›

These spaces are a part of normal development. The cranial bones remain separate for about 12 to 18 months. They then grow together as part of normal growth. They stay connected throughout adulthood.

Why are there sutures on the human skull What does this tell you about the actual structure? ›

The sutures are divisions between the bones on the skull. Early in life, these sutures allow for the growth of the skull and brain, and only later do they fuse together. This tells us that the skull is actually made up of several smaller bones, not one large bone.

Which suture does not have memory? ›

A newer monofilament suture material is polybutester (Novafil). Polybutester appears to be stronger than other monofilaments. This material does not have significant memory and does not maintain its packaging shape the way nylon and polypropylene do.

What is the most common suture? ›

Simple interrupted suture: It is the most common and simple form of suturing technique. The suture is placed by inserting the needle perpendicular to the epidermis. Inserting it perpendicularly helps in a wider bite of deeper tissue to be included in the suture than at the surface leading to rapid wound healing.

What's the difference between sutures and stitches? ›

Although stitches and sutures are widely referred to as one and the same, in medical terms they are actually two different things. Sutures are the threads or strands used to close a wound. “Stitches” (stitching) refers to the actual process of closing the wound. However, “suturing” is often used to mean stitching.

What are 8 cranial bones? ›

There are eight cranial bones, each with a unique shape:
  • Frontal bone. This is the flat bone that makes up your forehead. ...
  • Parietal bones. This a pair of flat bones located on either side of your head, behind the frontal bone.
  • Temporal bones. ...
  • Occipital bone. ...
  • Sphenoid bone. ...
  • Ethmoid bone.
24 May 2018

Where Are The sutures located? ›

Cranial sutures are syndesmosis between the cranial bones. A syndesmosis is a fibrous joint between two bones. The coronal suture is oblique in direction and extends between the frontal and the parietal bones.

When do the sutures of the skull close? ›

Around two years of age, a child's skull bones begin to join together because the sutures become bone. When this occurs, the suture is said to “close.” In a baby with craniosynostosis, one or more of the sutures closes too early. This can limit or slow the growth of the baby's brain.

How strong is the top of your skull? ›

Turns out the human skull can withstand 6.5 GPa of pressure, while oak holds up under 11, concrete 30, aluminum 69 and steel 200. Atop the charts is graphene, which Mattei described as "a monolayer lattice form of carbon," at 1,000 GPa.

Do cranial bones move? ›

Our data indicate that although the cranial bones move apart even with small (nominally 0.2 ml) increases in ICV, total cranial compliance depends more on fluid migration from the cranium when ICV increases are less than approximately 3% of total cranial volume.

Can you feel coronal suture? ›

When both coronal sutures are affected, a ridge can be felt on both sides of the head running from the top of the skull down the sides in front of the ears.

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