Cervicogenic headache is defined as a dull or aching pain in the occipital, top, temporal, or frontal regions of the head in the above mentioned areas, accompanied by upper neck pain, neck pressure, neck stiffness, or upper neck pain and limited movement with activity.
Diagnosis.
The diagnosis of cervicogenic headache can mostly be quickly established based on the location, nature, and signs of pain, as well as imaging CT or MRI, except for other organic diseases that can cause headache. The upper cervical paraspinal, lower posterior mastoid and head pressure points are important for the diagnosis of cervicogenic headache.
Treatment.
The principle of clinical treatment for cervicogenic headache should be mainly non-surgical. If the patient is found to have organic lesions in the neck, such as tension, stiffness, pressure and pain during activity in the soft tissues of the upper neck, or a reduced or restricted range of motion during activity, and inflammation of the synovial joints on imaging, local treatment should be focused on the lesion area of the upper neck, and every effort should be made to eliminate the inflammatory lesions in the local soft tissues.
I. General treatment
For patients with cervicogenic headache with short duration and mild pain, rest, head and neck acupuncture, traction and physical therapy can be taken, together with oral non-steroidal anti-inflammatory drugs, and the condition of some patients can be improved. In the acute attack exacerbation period, treatment should be based on rest, heat therapy and analgesia. Local massage, acupuncture, and oral NSAIDs can be effective. Rest in a hard bed and use a neck brace for protection when getting up. After the acute stage, physical therapy and self-torture can be started appropriately to exercise the cervical muscles. If the conservative treatment is ineffective and the attacks are frequent and affect the work and life, injection therapy and surgery should be considered for the stubborn cervicogenic headache.
II. Health education
During the treatment of cervicogenic headache patients, clinicians should pay attention to the necessary health education for patients.
1.Pay attention to maintaining good sleep, body position and working position
2.Pay attention to self-protection and prevention of trauma to the head and neck
3.Acute injury should be treated promptly
III. Injection therapy
The injection of anti-inflammatory and analgesic drugs in the corresponding focal area of patients with cervicogenic headache has obvious diagnostic effects, and at the same time can play a therapeutic role such as analgesia and relief of local muscle spasm. Injection therapy is an effective means of pain relief in both the acute and chronic phases. It is both an effective diagnostic tool and has obvious therapeutic effects.
Because the pathogenesis of cervicogenic headache is very complex and each patient has a different lesion site, injection therapy should adhere to the principle of individualization. Before administering injection therapy, the treating clinician should carefully analyze the patient’s condition, confirm the specific lesion site of each patient as much as possible, and formulate a targeted injection therapy plan for him/her.
Commonly used injection therapy methods
1.Injection of cervical paravertebral lesions: Puncture injection of anti-inflammatory and analgesic drugs in the transverse process of the 2nd cervical vertebra has good therapeutic effect for most patients with cervicogenic headache. The drug solution can flow into the C1-3 spinal nerve and surrounding soft tissues by diffusion in the intertransverse process, playing the therapeutic role of anti-inflammation, analgesia and promoting the recovery of nerve function. The therapeutic effect is better because the drug solution is injected directly into the lesion area. Since the body surface markers of the 2nd cervical transverse process are not easily palpable in the more obese, puncture injection treatment can also be performed under X-ray guidance.
2.Cervical articular eminence joint injection
3, cervical epidural space injection: the cervical paravertebral and head pressure pain point injection treatment is not effective, most of the lesions are located in the spinal canal, discogenic radiculitis caused by disc herniation is most common, the paravertebral injection solution can not reach the lesion. The cervical epidural space injection method can be used.
Fourth, surgical treatment
If the non-surgical treatment is not effective, the nerve root should be considered for surgical treatment because of the abnormal bony changes in the spinal canal. For patients with contraindications to surgery or greater risk of surgery, destructive block of the posterior medial branch of the cervical nerve can be used with the consent of the patient, and the treatment should be carried out under X-ray fluoroscopic guidance. The posterior medial branch of the cervical nerve can also be treated with radiofrequency thermocoagulation destruction.