08/27/2026
A 2017 review paper makes a pretty interesting argument for anyone who works with headaches.
Not every headache may be coming from inside the skull.
In some people with chronic migraine, especially those with occipital pain and significant scalp and neck tenderness, some of that nociceptive input may be coming from tissues outside the skull.
Periosteum. Fascia. Peripheral nerves.
And this has been part of our consideration with RAPID all along.
Weāve never looked at headache pain as something that automatically has to be driven entirely from inside the skull. Weāve always considered the highly sensitive interfaces around the skull and upper cervical region, especially the periosteum and connective tissue attachment sites, as potential contributors to the nociceptive picture.
Hereās where the research gets interesting.
Researchers biopsied the occipital periosteum of people with chronic migraine and compared it to controls. The migraine group had more inflammatory markers and fewer of the signals involved in resolving inflammation.
Even more interesting, sensory nerves connected with meningeal nociceptors can travel through the skull sutures into that same extracranial periosteum.
In other words, inside and outside may be talking to each other.
And think about where that periosteum is.
Right where your cervical and cranial muscles attach.
The tissue showing that inflammatory signature is literally sitting under our hands.
Now, this was a review paper proposing a possible mechanism. It wasnāt a randomized trial. It doesnāt mean migraine starts in fascia, and it definitely doesnāt mean weāre mechanically changing or āreleasingā anything.
What it does suggest is that the periosteum isnāt just passive tissue sitting underneath a headache.
It contains nociceptive nerve endings that may participate in trigeminocervical pain processing.
For us, thatās an interesting piece of research because it lines up with something weāve been considering clinically for a long time.
The tissues outside the skull matter.
That makes the periosteum a pretty interesting interface.
And one worth paying attention to.
Burstein R, Blake P, Schain A, Perry C. Extracranial origin of headache. Curr Opin Neurol. 2017;30(3):263-271.
