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Avijgan M, Thomas LC, Osmotherly PG, Bolton PS. A Systematic Review of the Diagnostic Criteria Used to Select Participants in Randomised Controlled Trials of Interventions Used to Treat Cervicogenic Headache. Headache 2019; 60:15-27. [DOI: 10.1111/head.13719] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Mahtab Avijgan
- School of Biomedical Sciences and Pharmacy Faculty of Health and Pharmacy University of Newcastle Callaghan NSW Australia
| | - Lucy C. Thomas
- School of Health Sciences University of Newcastle Callaghan NSW Australia
- School of Health and Rehabilitation Sciences University of Queensland St Lucia QLD Australia
| | | | - Philip S. Bolton
- School of Biomedical Sciences and Pharmacy Faculty of Health and Pharmacy University of Newcastle Callaghan NSW Australia
- Hunter Medical Research Institute New Lambton NSW Australia
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Choi KS, Ko Y, Kim YS, Yi HJ. Long-term outcome and prognostic factors after C2 ganglion decompression in 68 consecutive patients with intractable occipital neuralgia. Acta Neurochir (Wien) 2015; 157:85-92. [PMID: 25352089 DOI: 10.1007/s00701-014-2255-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 09/01/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Occipital neuralgia is a rare cause of severe headache characterized by paroxysmal shooting or stabbing pain in the distribution of the greater occipital or lesser occipital nerve. In cases of intractable occipital neuralgia, a definite cause has not been uncovered, so various types of treatment have been applied. The aim of this study is to evaluate the prognostic factors, safety, and long-term clinical efficacy of second cervical (C2) ganglion decompression for intractable occipital neuralgia. METHODS Retrospective analysis was performed in 68 patients with medically refractory occipital neuralgia who underwent C2 ganglion decompression. Factors based on patients' demography, pre- and postoperative headache severity/characteristics, medication use, and postoperative complications were investigated. Therapeutic success was defined as pain relief by at least 50 % without ongoing medication. RESULTS The visual analog scale (VAS) score was significantly reduced between the preoperative and most recent follow-up period. One year later, excellent or good results were achieved in 57 patients (83.9 %), but poor in 11 patients (16.1 %). The long-term outcome after 5 years was only slightly less than the 1-year outcome; 47 of the 68 patients (69.1 %) obtained therapeutic success. Longer duration of headache (over 13 years; p = 0.029) and presence of retro-orbital/frontal radiation (p = 0.040) were significantly associated with poor prognosis. CONCLUSIONS In the current study, C2 ganglion decompression provided durable, adequate pain relief with minimal complications in patients suffering from intractable occipital neuralgia. Due to the minimally invasive and nondestructive nature of this surgical procedure, C2 ganglion decompression is recommended as an initial surgical treatment option for intractable occipital neuralgia before attempting occipital nerve stimulation. However, further study is required to manage the pain recurrence associated with longstanding nerve injury.
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Affiliation(s)
- Kyu-Sun Choi
- Department of Neurosurgery, Hanyang University Medical Center, 17 Haengdang-dong, Seongdong-gu, 133-792, Seoul, Korea
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Cesmebasi A, Muhleman MA, Hulsberg P, Gielecki J, Matusz P, Tubbs RS, Loukas M. Occipital neuralgia: anatomic considerations. Clin Anat 2014; 28:101-8. [PMID: 25244129 DOI: 10.1002/ca.22468] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Revised: 08/20/2014] [Accepted: 08/27/2014] [Indexed: 12/21/2022]
Abstract
Occipital neuralgia is a debilitating disorder first described in 1821 as recurrent headaches localized in the occipital region. Other symptoms that have been associated with this condition include paroxysmal burning and aching pain in the distribution of the greater, lesser, or third occipital nerves. Several etiologies have been identified in the cause of occipital neuralgia and include, but are not limited to, trauma, fibrositis, myositis, fracture of the atlas, and compression of the C-2 nerve root, C1-2 arthrosis syndrome, atlantoaxial lateral mass osteoarthritis, hypertrophic cervical pachymeningitis, cervical cord tumor, Chiari malformation, and neurosyphilis. The management of occipital neuralgia can include conservative approaches and/or surgical interventions. Occipital neuralgia is a multifactorial problem where multiple anatomic areas/structures may be involved with this pathology. A review of these etiologies may provide guidance in better understanding occipital neuralgia.
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Affiliation(s)
- Alper Cesmebasi
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota; Department of Anatomical Sciences, School of Medicine, St. George's University, Grenada, West Indies
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Tuchin PJ, Pollard H. Does classic migraine respond to manual therapy – a case series. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/ptr.1998.3.3.149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Sahai-Srivastava S, Zheng L. Occipital Neuralgia With and Without Migraine: Difference in Pain Characteristics and Risk Factors. Headache 2010; 51:124-8. [DOI: 10.1111/j.1526-4610.2010.01788.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Occipital neuralgia. Headache 2010. [DOI: 10.1017/cbo9780511750472.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Tuchin PJ. A case of chronic migraine remission after chiropractic care. J Chiropr Med 2008; 7:66-70. [PMID: 19674722 PMCID: PMC2682939 DOI: 10.1016/j.jcme.2008.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2007] [Revised: 02/18/2008] [Accepted: 02/25/2008] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To present a case study of migraine sufferer who had a dramatic improvement after chiropractic spinal manipulative therapy (CSMT). CLINICAL FEATURES The case presented is a 72-year-old woman with a 60-year history of migraine headaches, which included nausea, vomiting, photophobia, and phonophobia. INTERVENTION AND OUTCOME The average frequency of migraine episodes before treatment was 1 to 2 per week, including nausea, vomiting, photophobia, and phonophobia; and the average duration of each episode was 1 to 3 days. The patient was treated with CSMT. She reported all episodes being eliminated after CSMT. The patient was certain there had been no other lifestyle changes that could have contributed to her improvement. She also noted that the use of her medication was reduced by 100%. A 7-year follow-up revealed that the person had still not had a single migraine episode in this period. CONCLUSION This case highlights that a subgroup of migraine patients may respond favorably to CSMT. While a case study does not represent significant scientific evidence, in context with other studies conducted, this study suggests that a trial of CSMT should be considered for chronic, nonresponsive migraine headache, especially if migraine patients are nonresponsive to pharmaceuticals or prefer to use other treatment methods.
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Affiliation(s)
- Peter J. Tuchin
- Senior Lecturer, Department of Chiropractic, Macquarie University, NSW 2109, Australia
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Sizer PS, Phelps V, Azevedo E, Haye A, Vaught M. Diagnosis and management of cervicogenic headache. Pain Pract 2006; 5:255-74. [PMID: 17147589 DOI: 10.1111/j.1533-2500.2005.05312.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Upper cervical pain and/or headaches originating from the C0 to C3 segments are pain-states that are commonly encountered in the clinic. The upper cervical spine anatomically and biomechanically differs from the lower cervical spine. Patients with upper cervical disorders fall into two clinical groups: (1) local cervical syndrome; and (2) cervicocephalic syndrome. Symptoms associated with various forms of both disorders often overlap, making diagnosis a great challenge. The recognition and categorization of specific provocation and limitation patterns lend to effective and accurate diagnosis of local cervical and cervicocephalic conditions.
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Affiliation(s)
- Phillip S Sizer
- Texas Tech University Health Science Center, School of Allied Health, Doctorate of Science Program in Physical Therapy, Lubbock, Texas 79430, USA.
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Abstract
Triplication of the lesser occipital nerve (LON) was observed bilaterally in an adult male cadaver during routine prosection of the posterior triangle. The three LONs were studied to determine the clinical importance of this variation. The origin of one LON was from a nerve to the trapezius that had a common origin with the trunk of the supraclavicular nerve (C3,4) from the cervical plexus. Such a common origin of a LON may explain the pain referred to the shoulder and arm that is experienced by some patients with cervicogenic headache. Another LON ran across the roof of the posterior triangle, passed through the trapezius and was closely related to the point of exit of the greater occipital nerve (GON) from the trapezius. This LON supplied the nape of the neck, back of the scalp and the auricle. The anomalous course taken by this LON through the trapezius may be an explanation for cervicogenic headache precipitated by neck movement. The close relationship of this variant LON to the exit of the GON from the trapezius seems to be relevant to the management of cervicogenic headache. The authors suggest that the reason for the complete pain relief experienced by some patients with cervicogenic headache by anesthetic blockade of the GON may be because both the GON and LON are blocked simultaneously due to their proximity in these patients.
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Affiliation(s)
- C Madhavi
- Department of Anatomy, Christian Medical College, Tamil Nadu, India
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De Araújo Lucas G, Laudanna A, Chopard RP, Raffaelli E. Anatomy of the lesser occipital nerve in relation to cervicogenic headache. Clin Anat 2005. [DOI: 10.1002/ca.980070207] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
Referred pain from disorders of the cervical spine can be perceived as headache. The mechanism is convergence between trigeminal afferents and afferents of the upper three cervical nerves in the trigeminocervical nucleus. Cervicogenic headache cannot be diagnosed on clinical grounds alone. The definitive criterion is complete relief of pain after controlled diagnostic blocks of cervical structures or their nerve supply. The most rigorously studied example of cervicogenic headache is third occipital headache.
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Affiliation(s)
- Nikolai Bogduk
- University of Newcastle, Department of Clinical Research, Royal Newcastle Hospital, Newcastle, NSW 2300, Australia.
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Piovesan EJ, Werneck LC, Kowacs PA, Tatsui CE, Lange MC, Vincent M. Bloqueio anestésico do nervo occipital maior na profilaxia da migrânea. ARQUIVOS DE NEURO-PSIQUIATRIA 2001. [DOI: 10.1590/s0004-282x2001000400012] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Na fisiopatologia da enxaqueca muitas estruturas estão envolvidas, sendo que o nervo trigêmeo pode ser considerado a estrutura principal. Com o objetivo de determinar a influência do nervo occipital maior (NOM) sobre o comportamento da enxaqueca, estudamos 37 pacientes que apresentavam crises de enxaqueca. Utilizando-se de um estudo duplo cego "cruzado" os pacientes foram submetidos a infiltração do NOM com bupivacaína 0,5% (BP) e soro fisiológicos 0,9% (SF), os efeitos clínicos após os bloqueios anestésicos foram avaliados: subjetivamente através da escala visual analítica para dor e objetivamente determinou-se os limiares de percepção dolorosa. A comparação entre os dois grupos (BP-SF) e (SF-BP) mostrou que: o número e a duração das crises em todos os momentos do estudo não mudaram; a intensidade das crises no grupo (BP-SF) foi menor somente depois da segunda infiltração (P=0,020), em todos os outros momentos não se observaram alterações significativas. Concluímos que o bloqueio anestésico com BP sobre o NOM não altera o número e a duração das crises de migrânea, porém promove uma redução média na intensidade das crises 60 dias após a sua infiltração. Os resultados mostrados sugerem que o NOM participa ativamente sobre a modulação nociceptiva durante as crises de enxaqueca sem aura.
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Abstract
Cervicogenic headache is pain perceived in the head but referred from a primary source in the cervical spine. The physiologic basis for this pain is convergence between trigeminal afferents and afferents from the upper three cervical spinal nerves. The possible sources of cervicogenic headache lie in the structures innervated by the C1 to C3 spinal nerves, and include the upper cervical synovial joints, the upper cervical muscles, the C2-3 disc, the vertebral and internal carotid arteries, and the dura mater of the upper spinal cord and posterior cranial fossa. Experiments in normal volunteers have established that the cervical muscles and joints can be sources of headache.
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Affiliation(s)
- N Bogduk
- Newcastle Bone and Joint Institute, University of Newcastle, Royal Newcastle Hospital, Newcastle, NSW 2300, Australia.
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Abstract
STUDY DESIGN The overall, local, and segmental kinematic responses of intact human cadaver head-neck complexes undergoing an inertia-type rear-end impact were quantified. High-speed, high-resolution digital video data of individual facet joint motions during the event were statistically evaluated. OBJECTIVES To deduce the potential for various vertebral column components to be exposed to adverse strains that could result in their participation as pain generators, and to evaluate the abnormal motions that occur during this traumatic event. SUMMARY OF BACKGROUND DATA The vertebral column is known to incur a nonphysiologic curvature during the application of an inertial-type rear-end impact. No previous studies, however, have quantified the local component motions (facet joint compression and sliding) that occur as a result of rear-impact loading. METHODS Intact human cadaver head-neck complexes underwent inertia-type rear-end impact with predominant moments in the sagittal plane. High-resolution digital video was used to track the motions of individual facet joints during the event. Localized angular motion changes at each vertebral segment were analyzed to quantify the abnormal curvature changes. Facet joint motions were analyzed statistically to obtain differences between anterior and posterior strains. RESULTS The spine initially assumed an S-curve, with the upper spinal levels in flexion and the lower spinal levels in extension. The upper C-spine flexion occurred early in the event (approximately 60 ms) during the time the head maintained its static inertia. The lower cervical spine facet joints demonstrated statistically greater compressive motions in the dorsal aspect than in the ventral aspect, whereas the sliding anteroposterior motions were the same. CONCLUSIONS The nonphysiologic kinematic responses during a whiplash impact may induce stresses in certain upper cervical neural structures or lower facet joints, resulting in possible compromise sufficient to elicit either neuropathic or nociceptive pain. These dynamic alterations of the upper level (occiput to C2) could impart potentially adverse forces to related neural structures, with subsequent development of a neuropathic pain process. The pinching of the lower facet joints may lead to potential for local tissue injury and nociceptive pain.
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Affiliation(s)
- J F Cusick
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee 53226, USA
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Piovesan EJ, Kowacs PA, Tatsui CE, Lange MC, Ribas LC, Werneck LC. Referred pain after painful stimulation of the greater occipital nerve in humans: evidence of convergence of cervical afferences on trigeminal nuclei. Cephalalgia 2001; 21:107-9. [PMID: 11422092 DOI: 10.1046/j.1468-2982.2001.00166.x] [Citation(s) in RCA: 114] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Cranial sensory innervation is supplied mainly by the trigeminal nerves and by the first cervical nerves. Excitatory and inhibitory interactions among those nerve roots may occur in a mechanism called nociceptive convergence, leading to loss of somato-sensory spatial specificity. Three volunteers in an experimental trial had sterile water injected over their greater occipital nerve on one side of the neck. Pain intensity was evaluated 10, 30 and 120 s after the injection. Two of the patients reported intense pain. Trigeminal autonomic features, suggestive of parasympathetic activation, were seen associated with trigeminally distributed pain. These data add to and reinforce previous evidence of convergence of cervical afferents on the trigeminal sensory circuit.
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Affiliation(s)
- E J Piovesan
- Setor de Cefaléias, Especialidade de Neurologia, Departamento de Clínica Médica, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Paraná, Brazil.
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A randomized controlled trial of chiropractic spinal manipulative therapy for migraine. J Manipulative Physiol Ther 2000. [DOI: 10.1016/s0161-4754(00)90073-3] [Citation(s) in RCA: 92] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Vernon H, McDermaid CS, Hagino C. Systematic review of randomized clinical trials of complementary/alternative therapies in the treatment of tension-type and cervicogenic headache. Complement Ther Med 1999; 7:142-55. [PMID: 10581824 DOI: 10.1016/s0965-2299(99)80122-8] [Citation(s) in RCA: 97] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES To conduct a systematic review of the randomized controlled clinical trials (RCTs) of complementary/alternative (CAM) therapies in the treatment of non-migrainous headache (i.e. excluding migraine, cluster and organic headaches). DESIGN Systematic review with quality scoring and evidence tables. MAIN OUTCOME MEASURES Number of RCTs per therapy, quality scores, evidence tables. RESULTS Twenty-four RCTs were identified in the categories of acupuncture, spinal manipulation, electrotherapy, physiotherapy, homeopathy and other therapies. Headache categories included tension-type (under various names pre-1988), cervicogenic and post-traumatic. Quality scores for the RCT reports ranged from approximately 30 to 80 on a 100 point scale. CONCLUSION RCTs for CAM therapies of the treatment of non-migrainous headache exist in the literature and demonstrate that clinical experimental studies of these forms of headache can be conducted. Evidence from a sub-set of high quality studies indicates that some CAM therapies may be useful in the treatment of these common forms of headache.
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Affiliation(s)
- H Vernon
- Canadian Memorial Chiropractic College, Toronto, Canada
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Jull G, Barrett C, Magee R, Ho P. Further clinical clarification of the muscle dysfunction in cervical headache. Cephalalgia 1999; 19:179-85. [PMID: 10234466 DOI: 10.1046/j.1468-2982.1999.1903179.x] [Citation(s) in RCA: 204] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The Headache Classification Committee of the International Headache Society listed impairments in cervical muscle function as criteria for headaches of cervical spine origin. Fifteen subjects with cervical headache and 15 controls were tested for the frequency of abnormal responses to passive stretching and abnormal muscle contraction. A new test of cranio-cervical flexion was used to assess the contraction of the deep neck flexors. Results indicated a trend towards a higher frequency of abnormal response to passive stretching of the muscles examined in the cervical headache group but only the upper trapezius proved significantly different to the control group. Deep neck flexor muscle contraction was significantly inferior in the cervical headache group. From the perspective of physical characterization of cervical headache, it appears that response from passive stretch of muscle may not be a strong criterion for cervical headache but deep neck flexor performance may have potential to identify musculoskeletal involvement in headache. The finding may also provide positive directions for conservative treatment of cervical headache.
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Affiliation(s)
- G Jull
- Department of Physiotherapy, University of Queensland, Brisbane, Australia.
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Piovesan EJ, Werneck LC, Kowacs PA, Tatsui C, Lange MC, Carraro Júnior H, Wittig EO. [Greater occipital neuralgia associated with occipital osteolytic lesion. Case report]. ARQUIVOS DE NEURO-PSIQUIATRIA 1999; 57:114-9. [PMID: 10347737 DOI: 10.1590/s0004-282x1999000100023] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The anatomic distribution of the greater occipital nerve during its path permits a close relationship with muscular structures, tendons, vessels and bones. The rupture of this relationship can origin its irritation and headache. We describe an uncommon association between an osteolytic lesion on occipital bone and greater occipital nerve. The patient, female 50, has been presenting headache for two years on the right occipital region spreading to the hemicranic and ipsilateral supraorbital region. The symptoms started spontaneously or by pressure on the trapezius tendon. The pain lasted about 30 minutes, compressive, mild intensity, with no autonomic symptoms and no improvement after the infiltration in the greater occipital nerve. The total improvement of the symptoms after releasing the nerve has allowed us to associate this lesion to the presence of algic symptoms.
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Affiliation(s)
- E J Piovesan
- Unidade de Cefaléias, Hospital de Clínicas, Universidade Federal do Paraná (UFPR), Curitiba, Brasil.
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Abstract
Headache related to the cervical spine is often misdiagnosed and treated inadequately because of confusing and varying terminology. Primary headaches such as tension-type headache and migraine are incorrectly categorized as "cervicogenic" merely because of their occipital localization. Cervicogenic headache as described by Sjaastad presents as a unilateral headache of fluctuating intensity increased by movement of the head and typically radiates from occipital to frontal regions. Definition, pathophysiology; differential diagnoses and therapy of cervicogenic headache are demonstrated. Ipsilateral blockades of the C2 root and/or greater occipital nerve allow a differentiation between cervicogenic headache and primary headache syndromes such as migraine or tension-type headache. Neither pharmacological nor surgical or chiropractic procedures lead to a significant improvement or remission of cervicogenic headache. Pains of various anatomical regions possibly join into a common anatomical pathway, then present as cervicogenic headache, which should therefore be understood as a homogeneous but also unspecific pattern of reaction.
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Sulfaro MA, Gobetti JP. Occipital neuralgia manifesting as orofacial pain. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1995; 80:751-5. [PMID: 8680985 DOI: 10.1016/s1079-2104(05)80261-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This is a case report and brief review of the literature on occipital neuralgia presenting as dental pain. A patient with a chief complaint of long-standing pain in the maxillary right posterior quadrant was evaluated. Dental examination demonstrated the pain was not of odontogenic origin. The patient was referred to a neurologist who was a chronic pain specialist and was diagnosed with a rare neurologic disorder, occipital neuralgia referring to the facial region. After conservative treatment, local nerve blocks, and physical therapy, the patient reported a dramatic improvement of symptoms and total absence of all orofacial pain. The case demonstrates an unusual cause of orofacial pain.
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Affiliation(s)
- M A Sulfaro
- Department of Cariology, Restorative Sciences, and Endodontics, University of Michigan School of Dentistry, Ann Arbor 48109-1078, USA
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Abstract
This is a case history of a 38-year-old woman with a dumbbell-shaped C2 neurofibroma associated with right-sided classic migraine headaches (migraine with aura) and cervical trigeminal signs on the affected side. Surgical removal of the tumor was followed by resolution of the migraine headaches and persistence of the signs of cervico-trigeminal involvement.
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Affiliation(s)
- L Goldhammer
- Center for the Study of Headache and Craniofacial Pain, Arlington, VA 22204
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Abstract
The origins of chronic headache and the role of the greater occipital nerve in headache syndromes are reviewed. The anatomical pathways and physiological basis of these headaches are discussed with a view to synthesizing some current concepts of headache generation. Studies of occipital nerve blockade for treatment of headaches of various types are assessed and a retrospective analysis of our own experience is presented.
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Affiliation(s)
- M J Gawel
- Sunnybrook Medical Centre, University of Toronto, Canada
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Abstract
This report defines the C2 and C3 pain dermatomes by the distribution of: the hypalgesia clearing after surgical root decompression; the dysaesthesias produced by electrical root stimulation; and the hypalgesia produced by anaesthetic root block. The C2 pain dermatome, so defined, consists of an occipital parietal area 6-8 cm wide, ascending paramedially from the subocciput to the vertex. The C3 pain dermatome is a craniofacial area including the scalp around the ear, the pinna, the lateral cheek over the angle of the jaw, the submental region and the lateral and anterior aspects of the upper neck. These C2 and C3 pain dermatomes do not overlap and are smaller than the C2 and C3 tactile dermatomes described in the literature.
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Affiliation(s)
- C E Poletti
- Neurosurgical Pain Service, Massachusetts General Hospital, Boston 02114
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Tanaka C, Biazotto W, Chopard RP, de Miranda Neto MH, Lucas GDG. [The connectivity between the greater occipital nerve and adjacent structures: anatomo-clinical considerations]. ARQUIVOS DE NEURO-PSIQUIATRIA 1991; 49:66-72. [PMID: 1863244 DOI: 10.1590/s0004-282x1991000100010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In order to offer anatomical basis that aid for clinical interpretation of headache of cervical origin a macro-mesoscopic study of greater occipital nerve and its subcutaneous rise out site was accomplished. The authors observed that in its course this nerve delineates angles and direction shifts that can stand for critical points in etiology of occipital pain, so that in its subcutaneous rise out region both occipital artery and vein shape the vasculo-nervous bundle wrapped by sheath of fibrous connective tissue which has continuity and contiguity relation with the adjoining epimysium and perimysium. From our results, anatomo-clinical aspects are discussed.
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Affiliation(s)
- C Tanaka
- Departamento de Anatomia, Universidade de São Paulo (USP), Brasil
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Abstract
It has been known for many years that headaches can originate from abnormalities in the neck. However, their clinical pictures were never sufficiently systematized, at least not in order to permit the research on their pathogenesis. Sjaastad et al. described in 1983 a group of patients with a very uniform and stereotyped headache. Attacks of mild, longlasting, unilateral head pain without sideshift, occurred every few weeks. The headache could be provoked by neck movements, such as extension, rotation or lateral flexion, as well as by external pressure towards trigger points in the neck. It usually started back in the neck, eventually spreading to the ipsilateral orbito-frontal-temporal or facial areas. The denomination "cervicogenic headache" (CH) was proposed. Its pathophysiology is presently unknown. The C2 and occipital nerve blockages eliminate the pain. We present a CH case and make some comments on its clinical picture, pathophysiology, and treatment.
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Affiliation(s)
- M Vincent
- Hospital da Universidade de Trondheim, Noruega
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Rosenberg WS, Swearingen B, Poletti CE. Contralateral trigeminal dysaesthesias associated with second cervical nerve compression: a case report. Cephalalgia 1990; 10:259-62. [PMID: 2272096 DOI: 10.1046/j.1468-2982.1990.1005259.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This 70-year-old woman presented with a left C2 solitary metastatic lesion producing ipsilateral occipital pain associated with contralateral fronto-orbital dysaesthesias. Examination revealed analgesia in the left C2 dermatome and hyperaesthesia in the right forehead. These symptoms and findings resolved following a course of radiation therapy to the C2 metastasis. Ipsilateral trigeminal dysaesthesias produced by cervical lesions have been described, however, contralateral cervicogenic trigeminal dysaesthesias have not. Relevant experimental data are analysed; neural pathways are suggested by which a cervical lesion, especially at C2 or C3, may produce trigeminal dysaesthesias referred ipsilaterally or contralaterally.
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Affiliation(s)
- W S Rosenberg
- Neurosurgical Service, Massachusetts General Hospital, Boston 02114
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Abstract
The diagnosis and treatment of patients experiencing head and neck pain is a difficult task for any clinician who pursues this area. The purpose of this paper is to elaborate upon a unilateral headache which is referred to as cervicogenic headache. The literature provides strong evidence demonstrating the relationship of the cervical spine and the possibility of referral pain to the head and facial areas.
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Affiliation(s)
- Michael Anthony
- Department of Neurology, Prince Henry Hospital; School of Medicine, University of New South Wales, Sydney, Australia
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Abstract
The main criteria of "cervicogenic headache" are considered to be as follows: relatively rare and long-lasting unilateral attacks of severe headache, although seemingly of a non-excruciating character, signs of neck involvement, and lack of "cluster pattern". In the present communication, the clinical manifestations in 11 patients fulfilling these criteria are described. All 11 patients selected in accordance with these criteria proved to be females, the age at onset ranging from 6 to 40 years (mean, 30 years). The mean duration of symptoms was 13 years. Six patients had had previous head/neck injuries. All patients had pain periorbitally, in the temporal region, and in the low occipital region (nape of the neck); less frequent were frontal, parietal, and facial pain and pain in the upper part of the occipital region. The duration of attacks was from 3 h to 3 weeks, and the interval between attacks lasted from 2 days to 2 months. The commonest accompanying phenomena were phonophobia, dizziness, ipsilateral eyelid edema, ipsilaterally blurred vision, and irritability. Some of the patients also had nausea (n = 7) and vomiting (n = 6). On physical examination, slight to moderate reduction of movements in the neck was noted, and five patients had ipsilaterally reduced sensation for touch in the trigeminal area. All the patients except one were severely afflicted. Attacks could, in addition to occurring spontaneously, be precipitated in all patients by head movements or by pressure at specific points in the neck.
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