A teacher with headache, dizziness, vomiting and vomiting from staying up late went to the hospital for emergency treatment, and the proposed diagnosis of cerebrovascular lesion was treated with various treatments such as vasodilation, dehydration and pain relief, but the results were not good. The next morning, he was transferred to the rehabilitation department and was diagnosed with cervical spondylosis after examination, and recovered quickly from his condition with comprehensive treatment such as physiotherapy and closure. Perhaps readers may wonder how a headache can also be related to cervical spondylosis.
Cervicogenic headache is a headache caused by the stimulation of the nerves in the neck. The usual headache is caused by the lesion of the head itself. Since this disease is a special manifestation of cervical spondylosis, treating this disease with the same method as treating head diseases will result in half the effort, and the result at the beginning of this article will occur.
So, how does cervicogenic headache occur? What are the manifestations and how to diagnose, treat and prevent it? The following is an introduction to these questions.
I. Pathogenesis of cervicogenic headache
(1) Relationship between anatomical basis and cervicogenic headache
The higher cervical nerves include the 1st to 4th cervical nerves, which are closely related to headache. The 1st cervical nerve is distributed to the posterior cephalic muscle group, and the posterior branch of this nerve is rich in sensory nerve fibers. The 2nd cervical nerve together with fibers from the 3rd cervical nerve form the greater occipital nerve, the lesser occipital nerve, and the greater auricular nerve, which are the main nerves that conduct cervicogenic headaches. The branches of these nerves enter the anterior cranial cavity at an angle and are susceptible to irritation and injury by the vertebral prominence and muscles at the point of attachment, resulting in hyperalgesia, hypersensitivity or pain in the scalp. In addition, afferent branches from the olfactory nerve, facial nerve, linguopharyngeal nerve, vagus nerve and trigeminal nerve are adjacent to the afferent fibers of the posterior roots of the 1st to 3rd cervical nerve in the 1st to 2nd segment of the cervical medulla, so when these cervical nerves are stimulated by compression or inflammation, there may be involved head pain, tinnitus, eye swelling and changes in smell and taste, similar to the manifestations of sinus, ear or eye diseases.
(ii) Cervical spine and intervertebral disc degeneration causing intervertebral foraminal stenosis
Degenerative degeneration or herniation of the cervical intervertebral disc causes the intervertebral foramen to become deformed and narrowed. At this time, the nerves and blood vessels that pass through the intervertebral foramen can be stimulated by compression, strain, angulation and inflammation. In addition to directly producing radicular pain (upper extremity radiating pain), the release of inflammatory mediators from nerve endings, resulting in soft tissue inflammation within the distribution area may also produce neck and head symptoms.
(iii), muscle spasm
Long hours of low head ambulation work, muscle contraction leads to reduced blood supply due to extrusion of blood vessels in the muscle, secondary to muscle spasm, causing tissue ischemia, metabolite aggregation, causing soft tissue injury and myofasciitis, as the 1st, 2nd and 3rd cervical nerves leave the spinal canal most of the path in the muscle tissue, they will be stimulated by inflammation, ischemia, injury and compression of soft tissues in the cervical lesion, and through its influence on the head nerves associated effects, triggering cervicogenic headaches. In addition, long and tedious mental talk or physical labor is most likely to cause cervical neuromuscular tension among all parts of the body, which is also a common cause of cervicogenic headache in adolescents.
II. Clinical manifestations
Patients with cervicogenic headache have a wide range of ages and are more common in females. Those with longer duration of the disease have decreased work efficiency, reduced attention and memory, depressed mood, irritability, irritability, easy fatigue, and significantly reduced quality of life and work. In the early stage, it is mostly discomfort, stuffiness or soreness in the occipital region, behind the ear and lower part of the ear, and pain gradually appears. It also extends to the forehead, D, top, and neck. It may be accompanied by pain in the upper extremity of the ipsilateral shoulder and back. Cold, exertion, alcohol consumption, and emotional excitement may induce the pain to worsen. The headache can be relieved by applying pressure to the painful area with a hand or by taking oral NSAIDs.
Physical examination may reveal significant pressure pain in the paracervical vertebrae below the ear and behind the mastoid process. For longer duration of disease, there may be pressure points at the back of the neck, D, top, and occipital regions. X-ray examination shows degenerative changes of the cervical spine to different degrees, while CT examination shows no special changes. cervical disc herniation can be seen in a few patients, but it does not necessarily correlate with the location and degree of pain.
Diagnosis
The diagnosis of cervicogenic headache can be quickly determined according to the symptoms, pain location, nature and signs, and excluding other organic diseases that can cause headache. The upper cervical paravertebral area, the posterior part of the inferior mastoid process, and the pressure point of the head are the important basis for the diagnosis of cervicogenic headache. For patients with atypical symptoms and signs, cervical nerve local anesthetic block can be performed as diagnostic treatment. If the pain is rapidly reduced or disappears after the injection, it will help to establish the diagnosis.
IV. Treatment of cervicogenic headache
(I) General treatment
For patients with short duration and mild pain, rest, physiotherapy, acupuncture, massage, traction and oral NSAIDs such as Fenbid can be taken. The condition of a part of patients can be improved.
(ii) Cervical spine injection
Injecting anti-inflammatory and analgesic drugs in the 2nd cervical transverse process, the drug can diffuse into the 1st and 3rd cervical nerves and surrounding soft tissues, exerting anti-inflammatory and analgesic effects. For those who have pressure pain in the occipital region and head, pressure pain point injection should be performed at the same time. If the treatment via cervical paravertebral and head pressure pain points is not effective, epidural cervical injection can be performed. Injection therapy has good therapeutic effect on most patients with cervicogenic headache.
V. Prevention
(a) The soft tissues of the back of the neck and shoulder are easily damaged by the slanting neck, low head and shrugging shoulders of the assembly workers in the assembly line and the heavy physical laborers such as throwing, throwing, pulling and pushing, so the poor posture and position at work should be corrected and changed first.
(B) intermittent farsightedness: when the ambulatory workers must be a long time close reading or operation, should be in the ambulatory case after a period of time (about an hour), look up for half a minute, to continue to study or work after eye fatigue subsided.
(C) the configuration of the appropriate height of the work, study table: the neck flexion-like posture in the daily work, learning is most common, must be adjusted. The principle is to head, neck, chest to maintain the normal physiological curve as the standard, the current market chairs are standard, its height is not suitable for people of different heights, therefore, where the height of more than one meter eight or one meter six below, should be adjusted by adjusting the height of the chair to adjust the study, work surface. For people who need to work for a long time, can be equipped with a sloping desk, work board or sloping reading board to reduce the degree of cervical flexion.
(D) increase activities: those who work long hours should do cervical spine exercises or workplace exercises to protect the cervical spine. At least one hour should be full body and neck activities for five minutes. According to their actual situation, such as age, physical fitness, general condition, occupational characteristics, hobbies and so on, they should insist on long-term physical exercise.
(v) Avoid prolonged head-down reading, playing cards and prolonged sitting, or lying down and turning your head to watch TV. From daily personal hygiene, household chores, to eating, sleeping and other activities, should maintain the correct posture and body position.
(6) When the human body is in a state of mental tension, depression, depression or boredom, the feeling of neck pain or headache is more obvious, which is medically called tension headache or neck pain. Cervical spondylosis easy patients, should pay more attention to adjust their psychological state, remove tension factors, to achieve a combination of work and rest, in order to reduce the occurrence of cervical spondylosis.