Head zones

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 14.09.2021

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Synonym(s)

Head Zones; Hyperalgesic zones

Definition
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Segmental skin hyperalgesia and hyperaesthesia in disease of internal organs. The skin zones with the sensitive supply from the same spinal cord segment as the diseased internal organs are affected. The visceral pain impulse is transmitted via a viscerocutaneous reflex and is also called "transmitted pain".

In clinical diagnostics, this phenomenon is also referred to as head-zone rehearsal (also Kalchschmidt rehearsal).

Furthermore, visceral pain can project to muscle segments of the corresponding nerve segment (Mackenzie zone).

Examples of Head's projections are, for example, the radiating pain in myocardial ischemia (projection of the pain onto a variable area extending from the ear to the navel) or in inflammations affecting the parietal pericardium (pericardial pain).

General information
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Head had already pointed out the existence of"maximum points". Here there are points of reference to Chinese medicine. Two important groups of acupuncture points, the diagnostically relevant Mu and Shu points, correspond spatially and functionally to a large extent with maximum points of Head's zones. A comparison of Head's work with the Huang Di Neijing (Inner Classic of the Yellow Thearch) and the Zhen Jiu Jia Yi Jing (Systematic Classic of Acupuncture and Moxibustion), two of the oldest surviving Chinese sources on acupuncture, revealed astonishing parallels between the two concepts. On the one hand regarding the location of the points and on the other hand regarding the functional aspects. Chinese medicine uses Mu and Shu points not only diagnostically but also therapeutically.

Occurrence
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Assignment of dermatome and organs

  • heart: C 3-4, Th 1-5, predominantly right, also left arm
  • Aorta thoracica: C 3-4, Th 1-7, bilateral
  • Pleura: Th 2-12 of the respective half of the body (ipsilateral)
  • Lungs: C 3-4, ipsilateral
  • Oesophagus: Th 1-8, both sides
  • Stomach: Th (5) 6-9, left
  • Liver and bile ducts: Th (5) 6-9 (10), right
  • Pancreas: Th 6-9, left side
  • Duodenum:Th 6-10, right
  • Jejunum: Th 8-11, left
  • Ileum:Th 9-11, on both sides
  • Appendix, proximal colon: Th 9-10, L 1, right
  • Distal Colon:Th 9 - L 4, left
  • Rectum:Th 9 - L 4, left
  • Kidney and ureter, Th 9 - L 1 (2), ipsilateral
  • Adnexes:Th 12 - L 4, ipsilateral
  • Peritoneum:Th 5-12, bilateral
  • Spleen:Th 6-10, left

Note(s)
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In fact, Head's findings were already not new in his time. To be precise, they are already more than 2000 years old. They are firmly anchored in Chinese medicine. However, Head's work led Western medicine to focus more intensively on the segmental-reflector relationships between visceral organs and the skin, the viscero-cutaneous reflexes.

Literature
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  1. Beissner F et al. (2011) Forgotten Features of Head Zones and Their Relation to Diagnostically Relevant Acupuncture Points. 2011: 240653 https://doi.org/10.1093/ecam/nen088

  2. Hauser W (1970) The significance of viscero-cutaneous reflexes in the pathogenesis of dermatoses. In: HA Gotton and W Schoenfeld. Dermatologei und Veneroloogie, supplementary volume, Georg Thieme Verlag Stuttgart pp.329-388.
  3. Putz, R (ed.): Sobotta, Atlas of human anatomy. Volume 2, 20th edition. Urban & Schwarzenberg, Munich 1993, p. 346.

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Last updated on: 14.09.2021