Citing Duan Quan, Department of Acupuncture and Moxibustion, Guangdong Provincial Hospital, Guangdong Province, PPT class definition
The Cervicogenic Headache Society describes cervicogenic headache as.
Dull pain or soreness in the occipital, top, temporal, frontal, or orbital regions of the head or both of these areas.
It is also accompanied by upper neck pain, neck pressure, neck stiffness, or upper neck pain and limited movement with activity, and is most often associated with a history of head and neck injury. Zheng Lin, Department of Traditional Chinese Medicine and Orthopedic Injury, Gucheng County People’s Hospital
Diagnostic criteria of the International Headache Society
A) Pain fixed in the neck and occipital region, which can radiate to the temporal region, the top or the ear.
B) Pain that worsens with specific neck movements or postures.
C) Includes at least one of the following.
1. limitation of passive neck movements,
2. altered appearance, structure, activity and passive stretch response of the neck muscles,
3. abnormal muscle pressure pain.
D) Radiological examination reveals at least one of the following.
1. abnormal extension and flexion movements.
2. abnormal body position.
3. fractures, congenital anomalies, bone tumors, rheumatoid arthritis or other pathologic changes.
Diagnostic criteria of the International Pain Society
I I Unilateral headache without contralateral involvement.
Ⅱ Signs and symptoms of neck involvement.
a Pain characteristics.
1. pain of a similar nature, caused by neck movements and or a single prolonged head posture
2. The distribution and characteristics of the pain are similar and can be caused by extrinsic pressure from the unilateral upper neck, posterior or occipital region.
b Unilateral non-radicular pain in the neck, shoulder and upper extremity.
c Decreased range of motion of the cervical spine.
Diagnostic criteria for cervicogenic headache in the clinical practice of the pain department of Beijing Xuanwu Hospital
Pain is concentrated on one or both sides
The upper cervical paravertebral area, the posterior part of the inferior mastoid process, and the pressure point of the head are important bases for the diagnosis of cervicogenic headache
The range of pain is in accordance with the distribution pattern
History of trauma to the head and neck
Diagnostic block
Imaging features: MRI of the cervical spine Disc changes Cervical spine-X-ray
Anatomical classification of cervicogenic headache
According to the different involved parts of the nerve roots.
Neurogenic pain: stimulation of sensory root fibers of the nerve roots
Myogenic pain: stimulation of ventral motor nerve roots
Pathogenesis
inflammatory theory
Intervertebral disc: compression, degeneration, etc.
Soft tissue: entrapment, hyperplasia, muscle spasm, etc.
Mechanical: osteophytes, joint instability, etc.
Other: bacterial inflammation; tumor; trauma; congenital or acquired deformity, etc.
Inflammatory theory – intervertebral discs
Cervical disc degeneration, herniation and release of disc material can directly cause aseptic inflammation and edema.
Produces immune rejection reactive inflammation, causing discogenic radiculitis.
Degenerated non-herniated discs can produce inflammatory mediators such as PLA2, IL-1, IL-6, TNF-Q, PGE2, histamine, 5- HT, NO, IgG, IgM, etc. These chemical factors are not only inflammatory and painful, but some have neurotoxic effects.
Inflammation theory – soft tissues
Inflammation, ischemia, injury, pressure and even inappropriate massage of soft tissues such as muscles and ligaments can affect the function of nerves and trigger cervicogenic headache.
In addition to irritation of cervical nerve roots that produce radicular pain, the release of inflammatory mediators from their terminals can cause soft tissue inflammation in the distribution area, which can also produce pain.
When the ventral motor nerve root (anterior root) is attacked by inflammation, it can cause reflex cervical muscle spasm. The persistent chronic muscle spasm causes tissue ischemia and hypoxia, which causes some metabolites such as lactic acid, bradykinin, substance P, 5-HT, etc. to be released and collected in muscle tissue, causing myofasciitis and pain, and can directly stimulate the nerve trunks and nerve endings traveling in soft tissue to produce pain.
Mechanical factors
The C2 transverse process is weak and prone to joint instability. Because the C2 transverse process is small and short, and the C2 spinous process is long and bifurcated, it is the lever arm for cervical flexion and extension movements, and is prone to injury causing joint instability in the upper cervical spine, resulting in headache.
The osteophytic vertebrae are close to each other, and the lateral hook vertebral joints are also close to each other, losing the normal relationship of the articular surfaces and deforming the intervertebral foramina. Violation of the intervertebral foramina and encroachment of the intervertebral space can cause pain and neurological dysfunction.
Treatment of cervicogenic headache
Non-invasive treatment: medication, psychological, transcutaneous electrical stimulation, acupuncture, tui-na, etc.
Minimally invasive treatment: injection therapy (paravertebral block, occipital nerve block), epidural injection (glucocorticoid, ozone), radiofrequency disruption,
Surgical treatment
Injection therapy
Injection of anti-inflammatory and analgesic drugs in the corresponding focal area, both for diagnostic and therapeutic purposes
Injections are an effective means of pain relief in both acute and chronic phases.
It is suitable for those with positive nerve block test.
The principle of individualization should be adhered to in injection therapy
Before injection therapy, carefully analyze the condition and confirm the specific site of the lesion
The injection treatment plan should be tailored for the patient.
The treatment plan should be evaluated and verified continuously during the course of treatment.
When the initial or initial two injections are not effective, the treatment plan should be rediagnosed and adjusted in a timely manner.
Precautions
(1) Since the markers of the 2nd cervical transverse process are not easily accessible in obese people, X-ray guided puncture treatment is available.
(2) There are individual differences in the positioning of the cervical transverse process and there are important nerves and blood vessels in the vicinity, so attention should be paid to anatomical positioning.
(3) After the vertebral artery turns laterally in the second cervical vertebra, the vertebral artery foramen opens laterally, which is easy to pierce when entering the needle, and it should be sucked back several times when entering the needle to prevent accidental entry into the vertebral artery.
(4) When injecting drugs, a small amount of test volume should be injected first, and then slowly injected without adverse reactions, and patients should be asked repeatedly about their feelings during the injection process to detect adverse reactions, such as dizziness, in a timely manner.
(5) Sometimes a transient Horner’s syndrome occurs when the drug flows forward to the superior cervical sympathetic ganglion, which may enhance the therapeutic effect.
(6) The drug should be prevented from accidentally entering the subarachnoid space during operation.