Progress in diagnosis and treatment of cervical headache

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Diagnosis of cervical headacheHeadache is a common disease in clinical diagnosis and treatment, when many of the causes, one of which is a h

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Diagnosis of cervical headache

Headache is a common disease in clinical diagnosis and treatment, when many of the causes, one of which is a headache with neck tenderness, and stimulation of the cervical nerve, high incidence, clinical manifestations are complex, long duration of headache, treatment is difficult, the people pay more attention to. This kind of headache in the past has been referred to as "nervous headache", "neurovascular headache", "pillow big nerve pain", "big nerve neuralgia", etc.. The headache is the head of the nerves and blood vessels in the pathogenic factors, treatment is the main method of oral non steroidal anti-inflammatory drugs, acupuncture, physiotherapy, massage head, head and head pain point injection nerve block (or occipital nerve and great auricular nerve block), but a considerable number of patients the condition is not improved or not lasting curative effect. This clinical situation promotes the further study on the pathogenesis of this kind of headache.

1983 Norway neurologist Sjaastad in "Journal" was first put forward the "headache cervicogenic headache" (Cervicogenic headache CEH) concept, and put forward the cervical headache definition and diagnostic criteria of [1] in 1990 and 1998. 1, neck symptoms and signs: (1) in the following cases of headache: neck activity and (or) the head to maintain abnormal position; press the headache side of the upper neck or pillow. (2) the limited range of movement of the neck; (3) the same side of the neck, shoulder or upper extremity non radicular pain, or occasionally upper extremity radicular pain. 2, the diagnosis of nerve block can be clearly diagnosed; 3, unilateral headache, not to the contralateral metastasis.

He put forward the headache is caused by organic or functional lesion caused by cervical and / or shoulder of the organization. Chronic unilateral head pain is a group of syndromes, the pain is referred to the nature of pain, diagnostic nerve block is one of the diagnostic criteria for cervical headache [2]. The patient presented with pain in the occipital region, which could be radiated to the head, the forehead and the forehead. Headache can be manifested as one side, or alternatively on both sides. A few patients with blurred vision, ear discomfort and tinnitus. Patients with neck stiffness, head and neck activity or fixed position of head and neck headache. The International Headache Society in the 2004 second edition of the standard for classification of headache disorders in the first edition of the cranial cervical muscle tension headache and whiplash headaches from cervicogenic headache in isolated [3]. To form a narrow neck headache. The upper cervical intervertebral disc herniation, local thickening of the yellow ligament and bone neoplasm and cervical fascia of greater occipital nerve, lesser occipital nerve and the cervical spinal nerve third occipital nerve compression is an important cause of a group. However, there was a significant proportion of patients with severe persistent headache or head and neck and shoulder pain who had no significant radiographic changes, but [4]. In the RF cervical disc arthroplasty in the treatment of cervical disc herniation associated with upper extremity radicular pain in the treatment of intervertebral disc stimulation can induce head pain, and these patients had pain is the original and most of them still occur even continue to feel the. After molding, the pain has been short or long gone. Therefore, some scholars believe that the cervical disc degeneration of the fibrous ring and the posterior longitudinal ligament with headache related nerve structure.

It was found by [5] that the sympathetic nerve fibers in the cervical sympathetic ganglion and the corresponding spinal branches of the C2 ~ 6 cervical nerve were formed into the sinus nerve. Immunohistochemical study showed that there were not only the posterior longitudinal ligament, but also a large number of sensory and sympathetic fibers. Gu Tao (2008) found that the experimental rabbit cervical posterior longitudinal ligament of sympathetic postganglionic fibers were mainly cross shaped distribution network, and the distribution in the intervertebral disc area is very dense. It is well known that the descending of the ascending and descending branches of the sinus and vertebral nerve into the spinal canal, and then extend to the deep and deep into the net [6]. Do not cross sensory nerve function in normal physiological conditions of sympathetic nerve and feel the pain, but the two after nerve injury not only by sympathetic sprouting occurred on the anatomy of the coupling, but also through the effects of sympathetic neurotransmitter chemical coupling. Sympathetic nerve by releasing neuropeptide Y amines to release substance P from sensory neurons more aggravated pain stimulation [6,7].

Cervical intervertebral disc annulus and posterior longitudinal ligament of the sympathetic nerve fibers is not only the neural basis of cervicogenic neck arm pain, is the neural basis of cervicogenic facial pain. In the pathogenesis of cervical headache, as well as the involvement of trigeminal nerve. Bogduk thinks the upper cervical nerve (C1 ~ C3) structure dominated by a ring pillow and atlantoaxial joint, C2 ~ 3 and C3 ~ 4 facet joint, disc and muscle fascia, occurs when the lesion of the upper cervical afferent nerve and the trigeminal nerve between the central central convergence mistaken for headache that is, cervicogenic headache is a pain involved. However, most of the branches of the trigeminal nerve and the upper cervical nerve can be converged to the greatest extent, so the cervical headache often occurs in the forehead [8]. We can see that most of cervical headache is related to cervical degeneration of more than 4. However, we were in the C5 ~ 6, C6 ~ 7 and C4 ~ 5 and the neck arm pain close cervical disc radiofrequency treatment, there are many original induced headache, and mitigated more lasting in RF after angioplasty. Coincidentally, the German Department of orthopedics doctor Diener (2007) has been reported also found [9]. However, C5 ~ 6, C6 ~ and C4 ~ 5 of these low cervical intervertebral disc and posterior longitudinal ligament and trigeminal nerve convergence there is no evidence. But because the spinal cord nerve and sympathetic contact with the characteristics of the network, the neck upper and lower segments of the network can not be separated, so the trigeminal nerve and the convergence should also show obvious upper neck, neck gradually weakening.

Two, the treatment of cervical headache

(a) conventional drug treatment includes non steroidal anti-inflammatory drugs, muscle relaxants, blood circulation drugs and tricyclic antidepressants.

(two) injection therapy

It can be used for the injection of anti-inflammatory, analgesic and neurotrophic drugs in the corresponding lesion area and peripheral nerves, which can be used to relieve pain and relieve local muscle spasm. Injection therapy is an effective method to relieve pain in both acute and chronic stages.

1 cervical transverse injection is especially suitable for patients with local tenderness.

In the second cervical transverse process puncture injection of anti-inflammatory, analgesic, neurotrophic drugs, the majority of patients with cervical headache has a good therapeutic effect. In fifth the sixth transverse process of cervical vertebra puncture and injection of anti-inflammatory and analgesia, nerve nutrition drugs, has a good therapeutic effect for most patients with cervicogenic pain of neck and shoulder. Second cervical transverse process puncture injection of liquid medicine in the process of inter channel diffusion can flow to the first, 3 cervical nerve and surrounding soft tissue, play anti-inflammatory, analgesic and stable nerve response. The same is true for the treatment of lower cervical spine injection [10,11].

2 articular surface injection

The cervical vertebra 2 ~ 3 joint and the neck 3 ~ 4 facet joint surface injection has the application to the local tenderness headache patient. 4 ~ 7 cervical facet joint surface injection on local applicability of neck and shoulder pain in patients with [12] cervical tenderness.

3 on the top of the line pillow, small around the occipital nerve injection for acute onset, severe pain and tenderness on the upper line of patients.

4 cervical epidural injection has good curative effect for most patients with cervicogenic pain of neck and shoulder, also has a good therapeutic effect for most patients with cervicogenic headache.

5 the continuous injection of cervical epidural space catheter, the treatment effect is more lasting.

(three) radiofrequency ablation for the treatment of cervical nerve: the medial branch of the cervical spinal cord

Puncture of the groove between the lateral and transverse processes of the articular process. Internationally, the puncture needle was punctured to the adjacent 1/2 of the lateral articular facet and the transverse process of the second cervical vertebra, respectively, and then were treated with radiofrequency thermocoagulation ([13]). In order to improve the curative effect, Bogduk should be put forward since the oblique puncture needle, the electrode and the joint at a tangent, and parallel neural, temperature should be 90 degrees, the heating time is 60 seconds. The cure rate is about 40%, and the long-term effect is poor [14]. In order to improve the effect of treatment, doctors often inject 6% phenol solution or alcohol. Using two electrodes in parallel, bipolar radiofrequency can improve the cure rate. The same site should be the first local anesthetic nerve block, effectively do radiofrequency treatment. 2 the superior occipital nerve, the third occipital nerve and the lesser occipital nerve. Radiofrequency ablation of the 3 cervical intervertebral disc, which is the responsibility of the optic disc and posterior longitudinal ligament.

Animal experiments and cervical surgery and minimally invasive treatment of clinical experience [15], cervical headache patients with degenerative cervical posterior longitudinal ligament and intervertebral disc distribution of a large number of sensory nerve and sympathetic nerve fibers. Radiofrequency ablation can be used to locate these nerve fibers in the absence of open surgery. In order to eliminate the cervical headache. It is clear that the mechanism of the effect of radiofrequency treatment is clear after the coupling of sympathetic nerve and sensory nerve fiber and the convergence mechanism of sensory nerve and trigeminal nerve in the cervical headache.

Cervical headache is a common disease threatening human health. With the deepening of the research, the diagnosis and treatment will be improved and perfected.

 

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