Objective: To observe the effect of acupuncture in the treatment of cervicogenic headache and to explore the role of dermal nerve entrapment factors in the pathogenesis of cervicogenic headache; Methods: From June 2013 to June 2014, 68 patients with cervicogenic headache were treated by acupuncture release in the posterior occipital area at the acupuncture clinic of Guangxi University of Traditional Chinese Medicine, and the headache pain intensity (PPI) assessment classification was used as the observation index. The total effective rate of each patient was 82.3% at 3 months after treatment, and no recurrence was observed 6 months after treatment.
The clinical efficacy of acupuncture minimally invasive release treatment for cervicogenic headache is remarkable, and the acupuncture minimally invasive technique is worth promoting in the clinic. From June 2013 to June 2014, our acupuncture team observed the effect of performing acupuncture minimally invasive release in the occipital neck for cervicogenic headache, which is reported below.
1. Data and methods
1.1 Clinical data
All 68 cases of cervicogenic headache were from the acupuncture clinic of Guangxi University of Traditional Chinese Medicine, and all of them had headache as the first complaint. Among them, 37 cases were male and 31 cases were female, aged 17-76 years old, with an average of 45.6 years, and the disease duration was 0.3-29 years, with an average of 12.1 years.
The headache manifested as paroxysmal in 47 cases and persisted in 21 cases, and was graded according to the headache intensity assessment (PPI) [2], grade II in 9 cases, grade III in 13 cases, grade IV in 21 cases, and grade V in 25 cases. 21 cases were accompanied by dizziness, 11 cases by tinnitus, 17 cases by neck and shoulder discomfort, and 18 cases by upper limb numbness; 19 cases had no obvious trigger for the headache attack, and 39 cases complained of the presence of triggers; 27 patients had The patients had bad cervical posture habits such as long-term low head work or computer use; 43 cases could appear radiated pain by pressing specific points, and 25 cases did not appear radiated pain.
1.2 Diagnostic criteria
The diagnostic criteria of cervicogenic headache adopted in this paper were based on the diagnostic criteria proposed by Sjaastad in 1990 with the addition of evidence of occipital nerve entrapment
(1) Intermittent or persistent headache (unilateral at first) with ipsilateral cervical-occipital or shoulder pain, stiffness and other symptoms;
(2) Tension in the neck muscles, significant pressure pain, positive pressure pain in the C2 transverse process, and radiation to the ipsilateral head;
(3)The pain is reduced after occipital nerve block;
(4) X-ray film shows displacement of the superior cervical spine (C1-C2), axial deviation of the dentate process, loss of physiological pronation, straightening, or even reversion, and cervical osteophytes;
(5) Exclude headache caused by organic cranio-cerebral diseases, pentacranial diseases, cervical tumors, tuberculosis, etc.
The basis for determining posterior cervical nerve compression in the occipital and upper cervical regions [2]: (1) occipital major nerve compression: pressure pain at the inner 1/3 of the line between the occipital ridge and the mastoid process and at the midpoint of the line between C2 and the mastoid tip and simultaneous discharge pain to the head; (2) occipital minor nerve compression: pressure pain at the posterior border of the mastoid process or simultaneous discharge pain to the ipsilateral head; (3) auricular major nerve compression: pressure pain at the inferior border of the mastoid tip and the posterior border of the sternocleidomastoid muscle and (3) ear nerve entrapment: pressure pain at the lower edge of the mastoid tip and the posterior edge of the sternocleidomastoid muscle or discharge pain to the ipsilateral auricle.
1.3 Inclusion criteria
The above diagnostic criteria were met and the following conditions were met: (1) no infectious disease or serious visceral disease; (2) voluntarily signed the informed consent form, underwent all tests and treatment within the specified time and received follow-up; (3) the patient could tolerate the needle knife treatment.
1.4 Exclusion criteria
Do not meet the diagnostic criteria of cervicogenic headache: (1) pregnant and lactating women; (2) skin infection in the neck and occipital area broken; (3) unable to complete treatment and follow-up as specified.
1.5 Treatment method
The patient was placed in a prone position with the neck overflexed and the frontal pillow padded, and the following pressure points were marked with a marker at the left and right sides: (1) the pressure point behind the mastoid process; (2) the midpoint of the line between the mastoid process and the C2 spinous process; (3) the inner 1/3 intersection of the line between the occipital ridge and the mastoid process; (4) the pressure point 1.5-50 px away from the posterior median point at the level of the C2 spinous process. The skin was routinely disinfected, a perforated towel was laid, and local anesthesia was applied with 1 ml of 2% lidocaine solution at each point.
Operation: The incision is parallel to the longitudinal axis of the patient’s body, the needle body is explored slowly into the needle perpendicular to the skin surface, the tip of the needle reaches the bone surface after 2-3 longitudinal cuts, 2-3 transverse stripping, the needle is discharged, compression is applied to stop bleeding, and dressing is applied. Once a week, 4 times a course of treatment.
1.6 Observation index
Fill in the headache medical record and follow up by telephone. The efficacy was graded according to the modified pain intensity (PPI) [2] before treatment and at the end of 3 months after treatment: grade 0) no pain; grade Ⅰ has pain but can be easily ignored; grade Ⅱ has pain, which cannot be ignored and does not interfere with normal life; grade Ⅲ has pain, which cannot be ignored and interferes with concentration or requires medication for relief; grade Ⅳ has pain, which cannot be ignored and all daily activities are affected, but can accomplish basic Grade V has severe pain, which cannot be ignored and requires rest or bed rest.
The criteria for determining the efficacy [4]: cured: headache disappeared; improved: headache reduced, attack time shortened or period prolonged; invalid: no change in headache and other symptoms.
1.7 Statistical processing
Statistical treatment All data were analyzed by SPSS17.0 software package, and the pain classification at 6 months after surgery was compared with that before treatment by rank sum test, and the difference was considered statistically significant at P<0.05.
2. Results
After a course of minimally invasive needle knife treatment, the pain grading and efficacy are shown in Table 1 below.
Table 1 PPI grading before and after minimally invasive needle knife treatment in 68 patients (cases)
Time
Grade 0
Grade I
Grade II
Grade III
Level IV
Level V
Before treatment
0
0
9
13
21
25
3 months after treatment
11
16
27
8
5
1
Table 2 Clinical outcomes after minimally invasive needle knife treatment in 68 patients (%)
Time
Cure rate
Improvement rate
Invalidation rate
Total effective rate
3 months after treatment
27(39.7%)
29(42.6%)
12(17.6%)
82.3%
The above results showed that after one course of minimally invasive acupuncture treatment, the majority of patients had significant relief or improvement at three months postoperative follow-up by telephone or outpatient. The number of cases representing headache severity grade IV and grade V decreased from 21 to 5 and from 25 to 1, respectively, indicating that acupuncture minimally invasive has a significant effect in improving the clinical symptoms of headache in patients with cervicogenic headache, and the headache attacks were still significantly better in most cases than before treatment (P<0.05). The evaluation of clinical efficacy showed that 3 months after treatment, the cure rate was 39.7%, the improvement rate was 42.6%, and the failure rate was 17.6%, with an overall effective rate of 82.3%.
3.Discussion
The onset of cervicogenic headache may be related to several factors [5]. The anatomical convergence theory, mechanical stimulation theory, inflammatory edema theory, and muscle spasm theory represent the different views of researchers. The pathogenic factors may have their own focus in different individuals, and an in-depth study of the relationship between different factors and the pathogenesis of cervicogenic headache is essential to improve clinical practice.
The relationship between different factors and the development of cervicogenic headache is essential to improve the relevance of clinical treatment.
The dermatomal nerve, the greater occipital nerve, the lesser occipital nerve, the greater auricular nerve, and the higher cervical nerve, which are distributed to the head and neck, travel through the blood vessels, the carotid artery, the vertebral artery, and the tendons, fascia, ligaments, cartilage, and other tissues of the head and neck, which constitute the extracranial pain-sensitive tissue structures. The dermatomal nerve is superficially located and its main stroke is within the fascial layer. When the fascial tissues are under increased tension for various reasons, the dermatomal nerve is easily stimulated by compression, thus causing headache.
The main purpose of acupuncture treatment is to reduce the high tension of the occipital and cervical fascial tissues by cutting and releasing the fascial tissues and to relieve the compression and irritation of the dermatomal nerves, thus relieving the resulting headache. Therefore, if acupuncture release therapy can effectively relieve
The main cause of headache is closely related to dermal nerve entrapment.
The aim of this study was to observe the effectiveness of minimally invasive acupuncture treatment for cervicogenic headache and to investigate the causes of cervicogenic headache. The results showed that minimally invasive acupuncture treatment in the occipital and upper cervical regions had a significant effect on the relief of cervicogenic headache, and 27 patients were clinically cured after 3 months of treatment without recurrence. The total effective rate was 82.3%, indicating that the minimally invasive needle knife release can effectively relieve the nerve compression symptoms of cervicogenic headache patients.
In order to improve the clinical cure rate of cervicogenic headache patients, we should conduct more in-depth studies to determine the clinical typology of cervicogenic headache and explore more detailed treatment methods.