Barre-Lieou Syndrome is an often confusing, misdiagnosed and misunderstood cause of a vast array of neurologic based symptoms. Barre-Lieou Syndrome is named for the collective, yet independent work of Jean Alexandre Barre, M.D. who published his research in 1925 and Yong-Choen Lieou, MD who published his findings in 1928.
Each doctor wrote of patients displaying unexplainable symptoms of headache, pain and swelling on one side of the face, tinnitus, vertigo and dizziness, nausea, vomiting and other digestive distress, vision problems, radiculopathy type symptoms of neck, shoulder pain and numbness extending into the hands and fingers.
Theories developed out of Barre-Lieou’s work that these problems were being caused by injury to the neck, specifically the back (posterior) of the neck that was causing vertebrae compression on the network of nerves that traveled through the area.
The symptoms that Barre described included those that are now diagnosed as Cervicogenic headache. A 2020 paper called for doctors to recognize Barre’s work and influence in the treatment of these headaches. (1)
In the National Institute of health library publication STATPearls, (2) cervicogenic headache is described in this way: “A cervicogenic headache presents as unilateral (one sided) pain that starts in the neck. It is a common chronic and recurrent headache that usually starts after neck movement. It usually accompanies a reduced range of motion (ROM) of the neck. It could be confused with a migraine, tension headache, or other primary headache syndromes. . . .Common cause include arthritis of the C2-3 facet joint, whiplash injury, and traumatic injury.
Suggested treatments include:
- Physical therapy.
- Manipulative therapy and therapeutic exercise.
- Atlantoaxial joint intra-articular injection.
- Radiofrequency ablation
There is a musculoskeletal (structural) causes of headache: neck ligament damage and neck muscle weakness caused by tendon weakness and damage. A recent study (3) researchers examined the relationship and cause of migraine, co-existing tension-type headache, and neck pain in headache patients. One hundred forty-eight people participated in this study and reported reduced ability to perform physical activity owing to migraine (high degree), tension-type headache (moderate degree) and neck pain (low degree). One interesting fact of the study above is that only 1 in 9 of these patients suffered from migraine alone. This is something we see empirically in our office. Migraine is usually not an isolated problem but the symptom of many problems. Of these many problems are problems of tightness and muscle spasms. This can be a sign of muscle weakness and tendon damage being a culprit of the cause. Muscle spasm and imbalance was also seen as a structural cause of cervicogenic headache in an August 2019 paper. (4) A 2017 study in The Clinical journal of pain (5) demonstrates that migraine headache could be reproduced by finding and palpitating (gently pressing) these active trigger points. These trigger points (pain producers) were found in the splenius capitis, the upper trapezius), and the sternocleidomastoid muscles. Those same muscles examined in the above research.
Cervicogenic dizziness is a difficult to manage and understand disorder. This is demonstrated in a a recent study (6) describing these challenges which writes: “the condition remains to be enigmatic for clinicians dealing with the dizzy patients.” A problem is the often confused source of the dizziness, and the desire to bundle all symptoms as one condition when the dizziness may be caused by Benign paroxysmal positional vertigo; Bow hunter’s syndrome; Cervical vertigo; Whiplash-associated disorder and Barre-Lieou syndrome.
“Physiotherapy is a common treatment used for cervicogenic dizziness. Treatment of the cervical spine using manual therapy techniques shows moderate evidence in favor of its use.” (7)
1 Gorelov V. JA Barré’s historic article” On posterior cervical sympathetic syndrome”: A translation from French. Cephalalgia: an international journal of headache. 2020 Oct;40(11):1261-5.
2 Al Khalili, Yasir, Nam Ly, and Patrick B. Murphy. “Cervicogenic headache.” (2018).
3 Krøll LS, Hammarlund CS, Westergaard ML, Nielsen T, Sloth LB, Jensen RH, Gard G. Level of physical activity, well-being, stress and self-rated health in persons with migraine and co-existing tension-type headache and neck pain. The journal of headache and pain. 2017 Dec;18(1):46.
4 Benatto MT, Florencio LL, Bragatto MM, Lodovichi SS, Dach F, Bevilaqua-Grossi D. Extensor/flexor ratio of neck muscle strength and electromyographic activity of individuals with migraine: a cross-sectional study. Eur Spine J. 2019 Aug 9.
5 Florencio LL, Ferracini GN, Chaves TC, Palacios-Ceña M, Ordás-Bandera C, Speciali JG, Falla D, Grossi DB, Fernández-de-las-Peñas C. Active trigger points in the cervical musculature determine the altered activation of superficial neck and extensor muscles in women with migraine. The Clinical journal of pain. 2017 Mar 1;33(3):238-45.
6 Devaraja K. Approach to cervicogenic dizziness: a comprehensive review of its aetiopathology and management. European Archives of Oto-Rhino-Laryngology. 2018 Oct;275:2421-33.
7 Carrasco-Uribarren A, Rodríguez-Sanz J, López-de-Celis C, Fanlo-Mazas P, Cabanillas-Barea S. An upper cervical spine treatment protocol for cervicogenic dizziness: a randomized controlled trial. Physiotherapy Theory and Practice. 2022 Nov 18;38(13):2640-9.