Cervicogenic headache. The differentiation from common migraine. An overview

Common migraine and cervicogenic headache have many traits in common, so many that they may be mixed up. Both are unilateral headaches with a female preponderance. However, as for a number of variables, they differ. This first and foremost has to do with factors concerning the neck. In cervicogenic headache, the following symptoms and signs are present: a reduced range of motion in the neck; mechanical precipitation of attack, either by neck movements or by external pressure over the greater occipital nerve of the C2 root; ipsilateral shoulder/arm pain; unilaterality without side-shift. Similar findings are usually not made in common migraine. Typical migraine symptoms, such as nausea, vomiting, photophobia, and phonophobia also occur in cervicogenic headache, but less frequently and to a lesser degree. Operative procedures directed to occipital/nuchal structures may afford decisive differentiation between the two disorders. In our estimation, cervicogenic headache and common migraine are two distinct disorders, with their own clinical patterns, pathogenesis, treatment - and, in all probability, also prognosis.

Cervical analgesic facet joint arthrography

We report on our experience with cervical analgesic facet joint arthrography in 11 patients (30 joints), of whom nine had previous spinal surgery. In this type of patient we have found the procedure to be a diagnostic test as well as a preoperative guide to the neurosurgeon, but not a permanent therapy.

[Reflex syndromes in cervical osteochondrosis]

Clinical, biochemical, x-ray findings are available for 430 patients who demonstrated reflex syndromes of acute cervical osteochondrosis as well as evidence on functioning of peripheral and cerebral hemodynamics, neuromuscular and sympatheticoadrenal systems obtained at rheovasography, rheoencephalography, Doppler ultrasonography, electromyography, electroneuromyography, electroencephalography.

An anatomic and dynamic study of the greater occipital nerve (n. of Arnold). Applications to the treatment of Arnold's neuralgia

This study concerns the posterior ramus of the second cervical spinal n., or greater occipital of Arnold. By means of dissections in formalin embalmed cadavers, an attempt was made to define its winding course and to locate it in relation to clinical or radiographic landmarks, so as to provide a guide for infiltration of the nerve with local anesthetic. At the same time a dynamic study was made to elucidate the relations of the nerve to adjacent structures during the different movements of the neck. This allowed us to propose clinical tests of nerve involvement and to reveal the zones where the nerve is anatomically vulnerable.

[Rare complication of decompression laminectomy in a patient with cervical intramedullary tumor]

The authors describe a 28-year-old patient with cervical intraspinal tumour in whom permanent apnoea developed after decompression laminectomy and plastic operation of the dura. The patient was artificially ventilated and received intensive therapy but died 2 months after the operation for septic complications.

Extent of sympathetic blockade after stellate ganglion block with bupivacaine

A study of the extent of sympathetic blockade after stellate ganglion block was assessed using liquid crystal thermography. Two volumes (10 and 20 ml) of bupivacaine 0.5% plain were used. Irrespective of the volume used cranial sympathetic block always occurred and thoracic sympathetic block never occurred. While upper cervical block was present in all patients, lower cervical sympathetic block was present only in the 20-ml group (P less than 0.05). The larger volume was associated with a significant incidence of hoarseness due to spread of local anaesthetic onto adjacent laryngeal nerves.

The cervical zygapophysial joints as a source of neck pain

Diagnostic cervical medial branch blocks and zygapophysial joint blocks were used to test the hypothesis that the cervical zygapophyseal joints can be the source of pain in patients with idiopathic neck pain. Complete temporary relief of all symptoms was obtained in 17 out of 24 consecutive patients. Two major groups of patients were those with neck pain and headache stemming from the C2-3 joints, and those with neck pain and shoulder pain stemming from the C5-6 joints. Internal-control observations in nine of the 17 patients established the diagnostic validity of the blocks used. The high yield of positive responders in this study probably reflects the propensity of patients with zygapophysial joint syndromes to gravitate to a pain clinic when this condition is not recognised in conventional clinical practice.

Neuropeptide distribution in the cervico-thoracic paravertebral ganglia of the cat with particular reference to calcitonin gene-related peptide immunoreactivity

Paraffin sections of cervical and upper thoracic paravertebral ganglia of the cat were investigated by immunohistochemistry using antisera directed against calcitonin gene-related peptide (CGRP). The relationships of CGRP-immunoreactive structures to those exhibiting immunoreactivity to antisera against other regulatory peptides and dopamine-beta-hydroxylase (DBH), respectively, were studied in consecutive sections. Singly scattered CGRP-immunoreactive neuronal perikarya were observed in the superior and middle cervical ganglia as well as in the stellate ganglion. These neurons also displayed immunoreactivity to vasoactive intestinal polypeptide (VIP), and some additionally exhibited faint substance-P immunoreactivity. DBH- and neuropeptide Y-immunoreactive ganglion cells were not identical with CGRP-immunoreactive neuronal cell bodies. According to the immunoreactive properties of varicosities, which abut on CGRP/VIP-immunoreactive perikarya, three types of CGRP/VIP-immunoreactive ganglion cells could be distinguished: (1) CGRP/VIP-immunoreactive neurons being surrounded by somatostatin-immunoreactive nerve fibers, (2) neurons being approached by both DBH- and met-enkephalin-immunoreactive varicosities, and (3) neurons receiving both DBH- and neurotensin-immunoreactive fibers. The stellate and upper thoracic ganglia harbored clusters of intensely VIP-immunoreactive somata, which lacked CGRP-immunoreactivity. Fine somatostatin-immunoreactive and coarse CGRP-immunoreactive fibers were distributed within these clusters, whereas patches of neurotensin-immunoreactive fibers were complementarily arranged. At all segmental levels investigated, a few postganglionic neurons were approached by both CGRP-immunoreactive and substance P-immunoreactive varicosities, but lacked a VIP-immunoreactive innervation. Therefore, CGRP/substance P-immunoreactive fiber baskets appeared rather to be of extraganglionic origin than to emerge from intraganglionic CGRP/VIP/SP neurons.(ABSTRACT TRUNCATED AT 250 WORDS)

Evidence for the existence of a lateral cervical nucleus in mice, guinea pigs, and rabbits

The lateral cervical nucleus of carnivores is large and is thought to play a prominent role in somatosensory processing. In contrast, early studies indicated that rats, mice, guinea pigs, and rabbits did not have a lateral cervical nucleus. However, we reported the existence of a lateral cervical nucleus in rats as a result of studies using retrograde transport techniques. In the present study, similar techniques were used to examine the possibility that early studies also overlooked the lateral cervical nucleus in mice, guinea pigs, and rabbits. In each of these species, a retrograde tracer was injected into the thalamus. These injections labeled a small number of neurons contralaterally in the dorsal part of the lateral funiculi of rostral cervical segments. Mice had the greatest number of neurons projecting from the lateral cervical nucleus to the thalamus, and rabbits had the fewest.

MR imaging of the cervical spine: neurovascular anatomy

High-resolution surface-coil MR imaging reveals intricate anatomic detail of the cervical spinal canal and its neurovascular contents. Appreciation of the normal neurovascular anatomy provides a scientific foundation for the detection of disease. Sagittal, axial, and oblique MR images of normal subjects were correlated with comparable anatomic sections obtained with a cryomicrotome whole-organ sectioning technique. The anterior epidural venous plexus is a prominent structure in the cervical spinal canal and was consistently identified both with cryomicrotomy and with MR in sagittal and axial planes. Epidural veins can be displaced and distorted in patients with cervical disk disease. Nerve roots including dorsal and ventral rootlets were consistently identified on axial images coursing through the subarachnoid space. Oblique-plane imaging showed nerve roots "en face" in their respective foramina; this may be a useful imaging technique in the diagnosis of nerve root impingement.

[Diagnosis and therapy of vertebrogenic vertigo]

Functional disorders of the cervical spine may lead to vertigenous symptoms. The typical pathological finding in these patients is a hyperlordotic position of the cervical spine. This causes functional problems of the C0/C1 and C1/C2 joints. X-rays show morphological changes of the vertebrae and may also point to functional disorders. Physiotherapy is the most important treatment modality and preventative measure in static dysbalance of the cervical spine. sometimes chiropractic therapy by an experienced manual therapist or carefully directed infiltration therapy is necessary.

Septal afferents to the area dentata terminate on vasoactive intestinal polypeptide (VIP)-like immunoreactive, non-pyramidal neurons. An electron-microscopic immunocytochemical degeneration study in the rat

Thermic lesions in the medial septum of adult rats result in dark degeneration of terminal boutons in the stratum moleculare and hilus of the area dentata. While most of the degenerating terminals are in synaptic contact with non-reactive cells, part of them end on dendrites of VIP-like immunoreactive neurons.

[Thermographic studies with fluid crystals in peripheral nerve damage]

Common peripheral neurogenic lesion in various locations and of different origins were examined thermographically and the results were compared with those obtained by clinical and electromyographic methods. Lesions in the regions of the N. ulnaris and N. medianus can, except in the case of carpal tunnel syndrome, be identified without difficulty by thermography. The results obtained in the case of paresis of the radialis are non-specific, and thermographic examination of radicular lesions are also sometimes ambiguous. Damage in the plexus-brachialis and root region yield impressive results which, however, are not particularly useful.

[Function of proprioceptors of the cervical spine in the cervico-ocular reflex]

Disease of the cervical spine may cause vestibular vertigo. The anatomical basis for this type of cervical vertigo are the proprioceptive stretch receptors of the upper cervical joints. These are connected to the vestibular nuclei, and, thus, to ocular reactions (nystagmus). Quantitative data about this cervico-ocular reflex are still scarce since the reflex is strongly suppressed in healthy persons. However, suppression ceases in bilateral complete vestibular deficiency. We measured the cervico-ocular reflex in 6 patients with complete bilateral labyrinthine deficiency. One patient showed a complete absence of the reflex, which might be explained by degeneration of the vestibular nuclei. 5 patients showed a strong cervico-ocular reflex with a gain (relation of eye amplitude to head amplitude) of 0.35-1.0. This gain was present with stimulus frequencies of 0.15-0.65 Hz. Data on the proprioceptive sensory organ of the cervical column could be the basis for evaluation of the widely-discussed importance of diseases of the cervical spine in vertigo.

Chronic paroxysmal hemicrania. VII. Mechanical precipitation of attacks: new cases and localization of trigger points

Two new chronic paroxysmal hemicrania patients are described. In both, attacks can be precipitated mechanically by applying firm manual pressure to certain sensitive points on the neck, i.e. in the C2 area, in the transverse processes of the C4-C5 vertebrae, or beneath the posterior part of the skull on the symptomatic side. The most sensitive area seems to be the transverse process of C4-C5. Susceptibility to this type of attack is dependent on the flow of spontaneous attacks; attacks are easily precipitated in a phase with multiple spontaneous attacks, but are not readily precipitated otherwise. Under indomethacin protection, local tenderness is clearly diminished and attacks cannot be precipitated.

[Structural organization of preganglionic sympathetic neurons]

Distribution of marked preganglionic neurons over spinal nuclei and segments was studied in cats with the aid of microinjections of the horse-radish peroxidase into the cranial cervical ganglion. The major part of these neurons were revealed in the main part of the intermediolateral nucleus. A somewhat lesser number of the cells were found in the funicular part of the nucleus. In the T1 segment they constituted about 90% of cells containing the peroxidase. Other neurons were localized in the paraependymal and intercalative nuclei. In longitudinal sections of the spinal cord, the preganglionic sympathetic neurons projecting their axons into the cranial cervical ganglion, form a rostro-caudal chain made of small ensembles of cells.

Organization and sensory properties of small myelinated fibres in the dorsal cervical rami of the cat

A study using both anatomical dissection and electrophysiological recording has been made to analyse sensory components of the cervical dorsal rami in the cat. Particular attention has been paid to the physiological properties of Group III muscle afferents. The dorsal rami from C2 to C4 are composed of many nerve bundles that contain afferents from both muscle and skin. Bundles containing only cutaneous and only muscle afferents were identified and found to follow a relatively consistent pattern of organization within the ramus. In nerve bundles serving the biventer cervicis muscle, a population of Group III afferent fibres was identified that responded to strong localized pressure or localized stretch. Their receptive fields were generally small and situated on the muscle borders or in tendinous inscriptions. Such units comprised 73% of those with conduction velocities less than 20 m/s. Group III afferent fibres from neck muscles fired readily to intramuscular 6% sodium chloride, but were mostly not sensitive to bradykinin injected locally or intra-arterially.

Neck pain

Any structure innervated by the cervical spinal nerves can be a primary source of neck pain and referred pain to the head, upper limb or chest wall. The most likely sources of chronic pain are the cervical intervertebral discs and the cervical zygapophyseal joints. Disc pain can be diagnosed by provocative disc stimulation; zygapophyseal joint pain can be diagnosed by local anaesthetic blocks of the cervical dorsal rami. Disc pain can be treated by anterior cervical fusion and zygapophyseal pain by percutaneous radiofrequency neurotomy.

The human vertebral column at the end of the embryonic period proper. 2. The occipitocervical region

The present investigation of the cervical region of the vertebral column at eight post-ovulatory weeks is the first such study based on precise reconstructions of staged embryos. At the end of the embryonic period proper, a typical vertebra is a U-shaped piece of cartilage characterized by spina bifida occulta. The notochord ascends through the centra and leaves the dens to enter the basal plate of the skull. The median column of the axis comprises three parts (designated X, Y, Z) which persist well into the fetal period. They are related to the first, second and third cervical nerves, respectively. Part X may project into the foramen magnum and form an occipito-axial joint. Part Z appears to be the centrum of the axis. The articular columns of the cervical vertebrae are twofold, as in the adult: an anterior (atlanto-occipital and atlanto-axial) and a posterior (from the lower aspect of the axis downwards). Alar and transverse ligaments are present. Cavitation is not found in the embryonic period in either the atlanto-occipital or zygapophysial joints, and is generally not present in the median atlanto-axial joint either. Most of the transverse processes exhibit anterior and posterior tubercles. An 'intertubercular lamella' may or may not be present, i.e. the foramina transversaria are being formed around the vertebral artery. The spinal ganglia are generally partly in the vertebral canal and partly on the neural arches, medial to the articular processes. During the fetal period, the articular processes shift to a coronal position and this alteration appears to be associated with a corresponding change in the location of the spinal ganglia.

The clinical anatomy of the cervical dorsal rami

A detailed description of the anatomy of the cervical dorsal rami is provided on the basis of the past literature and independent studies on five cadavers. In particular, the anatomy of the upper cervical dorsal rami and the innervation of the cervical zygapophyseal joints are described. The clinical significance of the cervical dorsal rami is discussed in relation to headache, occipital neuralgia, and neck pain. The surgical anatomy of cervical facet denervation is discussed. The radiologic anatomy of the medial branches of the cervical dorsal rami is described, and target points suitable for diagnostic blocks or facet denervation are illustrated.

On the localization and mediation of the centrally induced hyperactive urinary bladder response to L-dopa in the rat

The hyperactive bladder response observed after central adrenergic stimulation with L-dopa, following enzymatic blockade of its peripheral metabolism, was studied in the rat. The bladder response was recorded by a cystometric procedure. The hyperactive bladder action thus produced was noted after transection of the CNS at the level of the superior colliculi but not when the transection was made caudal to the inferior colliculi. No effect was seen after transection of the cauda equina at L6, i.e. parasympathetic decentralisation of the bladder. It is concluded that the hyperactive bladder reaction seen after central adrenergic stimulation is produced in the mesencephalic-pontine region and mediated to the bladder via a central coupling to parasympathetic pathways.