Trigemino-Cervical reflex
Introduction
For a period of time, it was believed that there was an interaction between the trigeminal nerve reflexes and neck muscles in the form of the head retraction reflex that only occurs in pathological central nervous system lesions. Blink reflex is one of the trigeminal nerve reflexes that involves the facial nerve as the efferent nerve, causing the orbicularis oculi to contract, leading to an instant blink in both eyes. However, Ertekin et al. in 1995 proved that there is a physiological interaction between blink reflexes and neck muscle contraction, causing both to exist in response to trigeminal nerve stimulation[1].
Neurophysiology of the reflex
Stimulus: mechanical stimulation of the trigeminal nerve by tapping with hammer on the glabella or Electrical stimulation of the supraorbital or infraorbital branches of the trigeminal nerve in the orbital fossa.
Afferent: Trigeminal nerve
Center: Trigemino-cervical nucleus in the Medulla (primarily).
Efferent: Upper cervical motor nerves
Response: Contraction of the neck muscles.
Note: Various neck muscles were studied to record this reflex, including semispinalis capitis, trapezius and sternocleidomastoid muscles.[2]
Variation of the response
Ertekin has found that Mechanical stimulation (glabellar tapping) has faster response (Shorter latency) than electrical stimulation (nociceptive)[1]. Response can occur under general anaesthesia but with different stimulus parameters [3]. Moreover, response variability in duration as well as latency was also found in normal subjects above 50 years old[4]
Clinical importance
The trigemino-cervical response was abnormal in the patients with neurological conditions, e.g., trigeminal neuralgia[5], multiple sclerosis[6], tension-type headache [7], and spinal cord injuries [8]
References
- ↑ 1.0 1.1 Ertekin C, Çelebisoy N, Uludağ B. Trigemino-cervical reflexes in normal subjects. Journal of the Neurological Sciences. 1996 Nov;143(1-2):84–90.
- ↑ Lima D, Enio Alberto Comerlato, Tavares ES, Pinheiro DS, Manzano GM. Short-Latency Trigeminocervical Reflex Obtained Without Muscle Activation: Topographic Distribution and Methodological Approach. Journal of Clinical Neurophysiology [Internet]. 2024 Nov 13 [cited 2025 Dec 31];42(5):451–6.
- ↑ Lima D, Enio Alberto Comerlato, Denise Spinola Pinheiro, Gilberto Mastrocola Manzano. The feasibility and technical aspects of trigemino-cervical reflex elicitation in humans under general anesthesia. Clinical Neurophysiology. 2024 Mar 1;
- ↑ E. Kızıltan M, Gündüz A. Late component of trigemino-cervical reflex: changes according to age and gender. Neurological Sciences. 2020 Jan 31;41(7):1759–64.
- ↑ Nardone R, Matullo MF, Frediano Tezzon. The trigemino-cervical reflex in patients with trigeminal neuralgia. Neurological Research. 2005 Jan 1;27(1):36–40.
- ↑ Lazzaro VD, Restuccia D, Nardone R, Tartaglione T, Quartarone A, P. Tonali, et al. Preliminary clinical observations on a new trigeminal reflex. Neurology. 1996 Feb 1;46(2):479–85.
- ↑ Nardone R, Tezzon F. The trigemino-cervical reflex in tension-type headache. European Journal of Neurology. 2003 May;10(3):307–12.
- ↑ Nardone R, Höller Y, Orioli A, Brigo F, Christova M, Tezzon F, et al. Trigemino-cervical-spinal reflexes after traumatic spinal cord injury. Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology [Internet]. 2015 May;126(5):983–6. Available from: https://pubmed.ncbi.nlm.nih.gov/25270243/