1
|
Lo CN, Teo VYE, Manaff NFABA, Seow TCY, Harve KS, Leung BPL. A Cross-Sectional Study Exploring the Relationship between Work-Related, Lifestyle Factors and Non-Specific Neck and Shoulder Pain in a Southeast Asian Population. Healthcare (Basel) 2024; 12:1861. [PMID: 39337202 PMCID: PMC11431091 DOI: 10.3390/healthcare12181861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2024] [Revised: 09/09/2024] [Accepted: 09/14/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Non-specific neck and shoulder pain (NSNSP) is prevalent among working adults. The increased use of electronic devices and prevalence of remote working and study following the COVID-19 pandemic have raised concerns about the potential rise in such conditions. This study aims to investigate the associations between work-related, lifestyle factors and NSNSP in the adult Southeast Asian Singaporean population. MATERIALS AND METHODS An online survey was administered electronically to Singaporeans aged 21 and above. Demographic data, NSNSP prevalence, computer and smartphone usage durations, sleep patterns, and exercise frequency were captured after obtaining informed consent (SIT institutional review board approval #2023014). RESULTS A total of 302 validated responses were recorded, including 212 suffering from NSNSP versus 90 in the comparison group. The NSNSP group showed significantly longer smartphone usage (5.37 ± 3.50 h/day) compared to the comparison group (4.46 ± 3.36 h/day, p = 0.04). Furthermore, the NSNSP group had lower exercise frequency (2.10 ± 1.74 days/week vs. 2.93 ± 2.21 days/week, p < 0.01) and shorter weekly exercise duration (2.69 ± 3.05 h/week vs. 4.11 ± 4.15 h/week, p < 0.01). The average NSNSP severity in this group was 34.9 ± 19.96 out of 100, correlating significantly with age (r = 0.201, p < 0.01) and BMI (r = 0.27, p < 0.01). CONCLUSIONS This preliminary cross-sectional study examines characteristics of adult Southeast Asians with NSNSP post-COVID-19 pandemic. The findings indicate significantly longer smartphone use and less exercise in NSNSP respondents, with both age and body mass index (BMI) demonstrating significant correlations with NSNSP severity.
Collapse
Affiliation(s)
- Chi Ngai Lo
- Family Care Physiotherapy Clinic, 154 West Coast Road, West Coast Plaza, 01-86, Singapore 127371, Singapore
| | - Victoria Yu En Teo
- Health and Social Sciences Cluster, Singapore Institute of Technology, 10 Dover Drive, Singapore 138683, Singapore (K.S.H.)
| | | | - Tessa Chu-Yu Seow
- Health and Social Sciences Cluster, Singapore Institute of Technology, 10 Dover Drive, Singapore 138683, Singapore (K.S.H.)
| | - Karthik Subramhanya Harve
- Health and Social Sciences Cluster, Singapore Institute of Technology, 10 Dover Drive, Singapore 138683, Singapore (K.S.H.)
| | - Bernard Pui Lam Leung
- Health and Social Sciences Cluster, Singapore Institute of Technology, 10 Dover Drive, Singapore 138683, Singapore (K.S.H.)
| |
Collapse
|
2
|
Reddy A, Saad M, Kassis S, Assi P, Thayer WP, Esteve IVM. Challenges of Imaging the Greater Occipital Nerve Using Magnetic Resonance Imaging. Ann Plast Surg 2024; 93:S130-S131. [PMID: 39230299 DOI: 10.1097/sap.0000000000004086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
ABSTRACT Migraine headaches are a significant global health concern, frequently managed with varying levels of success. Compression of the greater occipital nerve (GON) is hypothesized to contribute to pathology in some migraine patients, making extracranial nerve decompression surgery a potential intervention for refractory cases. However, accurate methods to image the GON along its tortuous course still need to be explored. Our group has developed magnetic resonance imaging sequences to track the GON. Yet, many challenges were met, which included navigating the GON's complex anatomy, understanding anatomical variants, and designing advanced magnetic resonance imaging sequences and coils to image the posterior scalp. Addressing these hurdles is vital to capture and understand GON pathology and guide potential interventions.
Collapse
Affiliation(s)
- Anvith Reddy
- From the Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | | | | | | | | | | |
Collapse
|
3
|
Deodato M, Granato A, Martini M, Sabot R, Buoite Stella A, Manganotti P. Instrumental assessment of pressure pain threshold over trigeminal and extra-trigeminal area in people with episodic and chronic migraine: a cross-sectional observational study. Neurol Sci 2024; 45:3923-3929. [PMID: 38396170 PMCID: PMC11254968 DOI: 10.1007/s10072-024-07372-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/28/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Central and peripheral sensitization are characterized by widespread hyperalgesia that is manifested by larger pain extent area and reduction in pressure pain threshold (PPT). PPT decreases in patients with migraine not only over the trigeminal cervical complex but also throughout the body. METHODS A cross-sectional study was adopted to assess the local and widespread hyperalgesia in chronic and episodic migraine patients respect to healthy controls. The guidelines of Andersen's were used to evaluate the PPT bilaterally over 3 muscles in the trigemino-cervical complex (temporalis, sub-occipitalis, trapezius) and over 1 muscle far from this area (tensor fasciae latae). RESULTS Thirty subjects with episodic migraine (35.8 ± 2.82 years), 30 with chronic migraine (53.03 ± 19.79 years), and 30 healthy controls (29.06 ± 14.03 years) were enrolled. The interaction effect was present for the trapezius muscle with a significant difference between the right and the left side in episodic group (p = 0.003). A group effect was highlighted in all four muscles analyzed such as suboccipital (p < 0.001), temporalis (p > 0.001), trapezius (p < 0.001), and TFL (p < 0.001). PPT was usually higher in the control group than in the episodic group which in turn was characterized by higher PPT values than the chronic group. CONCLUSIONS People with chronic and episodic migraine presented lower PPT than healthy controls both in the trigeminal and in the extra-trigeminal area. People with chronic migraine presented lower PPT than episodic migraine only in the trigeminal area. Temporalis and sub-occipitalis are the most sensitive muscles in people with chronic and episodic migraine.
Collapse
Affiliation(s)
- Manuela Deodato
- Department of Medical, Surgical and Health Sciences, University of Trieste, Via Pascoli 31, 34100, Trieste, Italy.
- Azienda Sanitaria Universitaria Giuliano Isontina, Via Pascoli 31, 34100, Trieste, Italy.
| | - Antonio Granato
- Department of Medical, Surgical and Health Sciences, University of Trieste, Via Pascoli 31, 34100, Trieste, Italy
- Azienda Sanitaria Universitaria Giuliano Isontina, Via Pascoli 31, 34100, Trieste, Italy
| | - Miriam Martini
- Department of Medical, Surgical and Health Sciences, University of Trieste, Via Pascoli 31, 34100, Trieste, Italy
- Azienda Sanitaria Universitaria Giuliano Isontina, Via Pascoli 31, 34100, Trieste, Italy
| | - Raffaele Sabot
- Department of Medical, Surgical and Health Sciences, University of Trieste, Via Pascoli 31, 34100, Trieste, Italy
| | - Alex Buoite Stella
- Department of Medical, Surgical and Health Sciences, University of Trieste, Via Pascoli 31, 34100, Trieste, Italy
| | - Paolo Manganotti
- Department of Medical, Surgical and Health Sciences, University of Trieste, Via Pascoli 31, 34100, Trieste, Italy
- Azienda Sanitaria Universitaria Giuliano Isontina, Via Pascoli 31, 34100, Trieste, Italy
| |
Collapse
|
4
|
Saad M, Manzanera Esteve IV, Evans AG, Karagoz H, Kesayan T, Brooks-Horrar K, Sengupta S, Robison R, Johnson B, Dortch R, Thayer WP, Assi P, Gfrerer L, Kassis S. Preoperative visualization of the greater occipital nerve with magnetic resonance imaging in candidates for occipital nerve decompression for headaches. Sci Rep 2024; 14:15248. [PMID: 38956162 PMCID: PMC11219832 DOI: 10.1038/s41598-024-65334-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 06/19/2024] [Indexed: 07/04/2024] Open
Abstract
Occipital nerve decompression is effective in reducing headache symptoms in select patients with migraine and occipital neuralgia. Eligibility for surgery relies on subjective symptoms and responses to nerve blocks and Onabotulinum toxin A (Botox) injections. No validated objective method exists for detecting occipital headache pathologies. The purpose of the study is to explore the potential of high-resolution Magnetic Resolution Imaging (MRI) in identifying greater occipital nerve (GON) pathologies in chronic headache patients. The MRI protocol included three sequences targeting fat-suppressed fluid-sensitive T2-weighted signals. Visualization of the GON involved generating 2-D image slices with sequential rotation to track the nerve course. Twelve patients underwent pre-surgical MRI assessment. MRI identified four main pathologies that were validated against intra-operative examination: GON entanglement by the occipital artery, increased nerve thickness and hyperintensity suggesting inflammation compared to the non-symptomatic contralateral side, early GON branching with rejoining at a distal point, and a connection between the GON and the lesser occipital nerve. MRI possesses the ability to visualize the GON and identify suspected trigger points associated with headache symptoms. This case series highlights MRI's potential to provide objective evidence of nerve pathology. Further research is warranted to establish MRI as a gold standard for diagnosing extracranial contributors in headaches.
Collapse
Affiliation(s)
- Mariam Saad
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | | | - Adam G Evans
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Huseyin Karagoz
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Tigran Kesayan
- Department of Anesthesiology, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Krista Brooks-Horrar
- Department of Neurology, Tennessee Valley Healthcare System, Nashville, TN, 37212, USA
| | - Saikat Sengupta
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Ryan Robison
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
- Philips Healthcare, Nashville, TN, 37219, USA
| | - Brian Johnson
- Philips Healthcare, Nashville, TN, 37219, USA
- University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | | | - Wesley P Thayer
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Patrick Assi
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Lisa Gfrerer
- Division of Plastic and Reconstructive Surgery, Weill Cornell, New York, NY, 10065, USA
| | - Salam Kassis
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, 37232, USA.
| |
Collapse
|
5
|
Evans RW. The Postconcussion Syndrome and Posttraumatic Headaches in Civilians, Soldiers, and Athletes. Neurol Clin 2024; 42:341-373. [PMID: 38575256 DOI: 10.1016/j.ncl.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Posttraumatic headaches are one of the most common and controversial secondary headache types. After a mild traumatic brain, an estimated 11% to 82% of people develop a postconcussion syndrome, which has been controversial for more than 160 years. Headache is estimated as present in 30% to 90% of patients after a mild head injury. Most headaches are tension-type-like or migraine-like. Headaches in civilians, soldiers, athletes, and postcraniotomy are reviewed. The treatments are the same as for the primary headaches. Persistent posttraumatic headaches can continue for many years.
Collapse
Affiliation(s)
- Randolph W Evans
- Neurology, Baylor College of Medicine, 1200 Binz #1370, Houston, TX 77004, USA.
| |
Collapse
|
6
|
Peled ZM, Gfrerer L. Introduction to VSI: Migraine surgery in JPRAS open. JPRAS Open 2024; 39:217-222. [PMID: 38293285 PMCID: PMC10827495 DOI: 10.1016/j.jpra.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 12/13/2023] [Indexed: 02/01/2024] Open
Affiliation(s)
- Ziv M. Peled
- Peled Plastic Surgery, 2100 Webster Street, Suite 109, San Francisco, CA 94115, United States
| | - Lisa Gfrerer
- Surgery Plastic and Reconstructive Surgery Weill Cornell Medicine, 425 East 61st Street, 10th Floor, New York, NY 10065, United States
| |
Collapse
|
7
|
Ma D, Maimaitimin A, Wang Y. A Novel Ultrasound-Guided "Three in One" Approach Plus Interfascial Plane Blocks for the Treatment of Cervicogenic Headache. Local Reg Anesth 2024; 17:1-8. [PMID: 38323022 PMCID: PMC10843979 DOI: 10.2147/lra.s446667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 01/16/2024] [Indexed: 02/08/2024] Open
Abstract
Objective Cervicogenic headache (CEH) is a condition resulting from upper cervical spine dysfunction and associated structural and soft tissue abnormalities, significantly impacting patients' quality of life. To acquire better therapeutic results, we presented a novel ultrasound-guided "three in one" approach plus interfascial plane (IFP) blocks for the treatment of CEH. This approach allows for the modulation of C2 dorsal root ganglion (DRG), third occipital nerve (TON), and C3 medial branch with one-point puncture. Additionally, it allows for IFP blocks between the upper neck and occipital muscles within the same scanning plane. Patients and Methods We evaluated patients diagnosed with CEH from July 2021 to December 2022 in our pain clinic. We included those who did not respond to conservative treatment and single occipital nerve block, therefore received nerve block or pulsed radiofrequency (PRF) using the "Three in One" approach plus IFP blocks. The accuracy of the ultrasound-guided C2 DRG puncture procedures was confirmed through fluoroscopy with C-arm and the sensory testing of PRF. The therapeutic effect of these interventions was assessed using the numerical rating scale (NRS) scores during telephone follow-ups at 1, 3, and 6 months. Results Utilizing the "Three in One" approach, a total of 5 patients diagnosed with CEH underwent nerve block plus IFP blocks, while 2 patients underwent PRF plus IFP blocks. Employing ultrasound-guided C2 DRG puncture procedures, the needle tip's correct placement was confirmed through both fluoroscopy and sensory testing of PRF. Notably, none of the cases experienced any complications associated with the approach. Subsequent follow-up assessments revealed an improvement in the NRS scores for CEH in all patients. Conclusion The ultrasound-guided "Three in One" approach plus IFP blocks may be a potential effective method for the treatment of CEH.
Collapse
Affiliation(s)
- Danxu Ma
- Department of Anesthesiology and Pain Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Abulaihaiti Maimaitimin
- Department of Rheumatology and Immunology, Moyu Uighur Medicine Hospital, Xinjiang, People’s Republic of China
| | - Yun Wang
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| |
Collapse
|
8
|
Peled ZM, Gfrerer L, Hagan R, Al-Kassis S, Savvides G, Austen G, Valenti A, Chinta M. Anatomic Anomalies of the Nerves Treated during Headache Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5439. [PMID: 38025616 PMCID: PMC10662871 DOI: 10.1097/gox.0000000000005439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023]
Abstract
Background Headache surgery is a well-established, viable option for patients with chronic head pain/migraines refractory to conventional treatment modalities. These operations involve any number of seven primary nerves. In the occipital region, the surgical targets are the greater, lesser, and third occipital nerves. In the temporal region, they are the auriculotemporal and zygomaticotemporal nerves. In the forehead, the supraorbital and supratrochlear are targeted. The typical anatomic courses of these nerves are well established and documented in clinical and cadaveric studies. However, variations of this "typical" anatomy are quite common and relatively poorly understood. Headache surgeons should be aware of these common anomalies, as they may alter treatment in several meaningful ways. Methods In this article, we describe the experience of five established headache surgeons encompassing over 4000 cases with respect to the most common anomalies of the nerves typically addressed during headache surgery. Descriptions of anomalous nerve courses and suggestions for management are offered. Results Anomalies of all seven nerves addressed during headache operations occur with a frequency ranging from 2% to 50%, depending on anomaly type and nerve location. Variations of the temporal and occipital nerves are most common, whereas anomalies of the frontal nerves are relatively less common. Management includes broader dissection and/or transection of accessory injured nerves combined with strategies to reduce neuroma formation such as targeted reinnervation or regenerative peripheral nerve interfaces. Conclusions Understanding these myriad nerve anomalies is essential to any headache surgeon. Implications are relevant to preoperative planning, intraoperative dissection, and postoperative management.
Collapse
Affiliation(s)
- Ziv M. Peled
- From the Peled Plastic Surgery, San Francisco, Calif
| | - Lisa Gfrerer
- Department of Plastic Surgery, New York Presbyterian Weill Cornell Medical Center, New York, N.Y
| | | | - Salam Al-Kassis
- Division of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tenn
| | - Georgia Savvides
- Department of Medical Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Gerald Austen
- Division of Plastic Surgery, Massachusetts General Hospital, Boston, Mass
| | - Alyssa Valenti
- Department of Plastic Surgery, New York Presbyterian Weill Cornell Medical Center, New York, N.Y
| | - Malini Chinta
- Department of Plastic Surgery, New York Presbyterian Weill Cornell Medical Center, New York, N.Y
| |
Collapse
|
9
|
Chang IA, Wells MW, Wang GM, Tatsuoka C, Guyuron B. Nonpharmacologic Treatments for Chronic and Episodic Migraine: A Systematic Review and Meta-Analysis. Plast Reconstr Surg 2023; 152:1087-1098. [PMID: 36940145 DOI: 10.1097/prs.0000000000010429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
BACKGROUND Minimally invasive techniques for treatment-resistant migraine have been developed on recent insights into the peripheral pathogenesis of migraines. Although there is a growing body of evidence supporting these techniques, no study has yet compared the effects of these treatments on headache frequency, severity, duration, and cost. METHODS PubMed, Embase, and Cochrane Library databases were searched to identify randomized placebo-controlled trials that compared radiofrequency ablation, botulinum toxin type A (BT-A), nerve block, neurostimulation, or migraine surgery to placebo for preventive treatment. Data on changes from baseline to follow-up in headache frequency, severity, duration, and quality of life were analyzed. RESULTS A total of 30 randomized controlled trials and 2680 patients were included. Compared with placebo, there was a significant decrease in headache frequency in patients with nerve block ( P = 0.04) and surgery ( P < 0.001). Headache severity decreased in all treatments. Duration of headaches was significantly reduced in the BT-A ( P < 0.001) and surgery cohorts ( P = 0.01). Quality of life improved significantly in patients with BT-A, nerve stimulator, and migraine surgery. Migraine surgery had the longest lasting effects (11.5 months) compared with nerve ablation (6 months), BT-A (3.2 months), and nerve block (11.9 days). CONCLUSIONS Migraine surgery is a cost-effective, long-term treatment to reduce headache frequency, severity, and duration without significant risk of complication. BT-A reduces headache severity and duration, but it is short-lasting and associated with greater adverse events and lifetime cost. Although efficacious, radiofrequency ablation and implanted nerve stimulators have high risks of adverse events and explantation, whereas benefits of nerve blocks are short in duration.
Collapse
Affiliation(s)
| | | | - Gi-Ming Wang
- Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine
| | - Curtis Tatsuoka
- Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine
| | | |
Collapse
|
10
|
Bink T, Hazewinkel MHJ, Hundepool CA, Duraku LS, Drenthen J, Gfrerer L, Zuidam JM. Feasibility of Ultrasound Measurements of Peripheral Sensory Nerves in Head and Neck Area in Healthy Subjects. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5343. [PMID: 37829106 PMCID: PMC10566885 DOI: 10.1097/gox.0000000000005343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/06/2023] [Indexed: 10/14/2023]
Abstract
Background Current diagnostic methods for nerve compression headaches consist of diagnostic nerve blocks. A less-invasive method that can possibly aid in the diagnosis is ultrasound, by measuring the cross-sectional area (CSA) of the affected nerve. However, this technique has not been validated, and articles evaluating CSA measurements in the asymptomatic population are missing in the current literature. Therefore, the aim of this study was to determine the feasibility of ultrasound measurements of peripheral extracranial nerves in the head and neck area in asymptomatic individuals. Methods The sensory nerves of the head and neck in healthy individuals were imaged by ultrasound. The CSA was measured at anatomical determined measurement sites for each nerve. To determine the feasibility of ultrasound measurements, the interrater reliability and the intrarater reliability were determined. Results In total, 60 healthy volunteers were included. We were able to image the nerves at nine of 11 measurement sites. The mean CSA of the frontal nerves ranged between 0.80 ± 0.42 mm2 and 1.20 ± 0.43 mm2, the mean CSA of the occipital nerves ranged between 2.90 ± 2.73 mm2 and 3.40 ± 1.91 mm2, and the mean CSA of the temporal nerves ranged between 0.92 ± 0.26 mm2 and 1.40 ± 1.11 mm2. The intrarater and interrater reliability of the CSA measurements was good (ICC: 0.75-0.78). Conclusions Ultrasound is a feasible method to evaluate CSA measurements of peripheral extracranial nerves in the head and neck area. Further research should be done to evaluate the use of ultrasound as a diagnostic tool for nerve compression headache.
Collapse
Affiliation(s)
- Thijs Bink
- From the Department of Plastic, Reconstructive Surgery and Hand Surgery, Erasmus Medical Center Rotterdam, the Netherlands
| | - Merel H J Hazewinkel
- From the Department of Plastic, Reconstructive Surgery and Hand Surgery, Erasmus Medical Center Rotterdam, the Netherlands
| | - Caroline A Hundepool
- From the Department of Plastic, Reconstructive Surgery and Hand Surgery, Erasmus Medical Center Rotterdam, the Netherlands
| | - Liron S Duraku
- Department of Plastic, Reconstructive Surgery and Hand Surgery, Amsterdam UMC, Amsterdam, the Netherlands
| | - Judith Drenthen
- Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Lisa Gfrerer
- Division of Plastic and Reconstructive Surgery, Weill Cornell Medical Center, New York, N.Y
| | - J Michiel Zuidam
- From the Department of Plastic, Reconstructive Surgery and Hand Surgery, Erasmus Medical Center Rotterdam, the Netherlands
| |
Collapse
|
11
|
Robblee J. Breaking the cycle: unraveling the diagnostic, pathophysiological and treatment challenges of refractory migraine. Front Neurol 2023; 14:1263535. [PMID: 37830088 PMCID: PMC10565861 DOI: 10.3389/fneur.2023.1263535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/11/2023] [Indexed: 10/14/2023] Open
Abstract
Background Refractory migraine is a poorly described complication of migraine in which migraine has chronified and become resistant to standard treatments. The true prevalence is unknown, but medication resistance is common in headache clinic patient populations. Given the lack of response to treatment, this patient population is extremely difficult to treat with limited guidance in the literature. Objective To review the diagnostic, pathophysiological, and management challenges in the refractory migraine population. Discussion There are no accepted, or even ICHD-3 appendix, diagnostic criteria for refractory migraine though several proposed criteria exist. Current proposed criteria often have low bars for refractoriness while also not meeting the needs of pediatrics, lower socioeconomic status, and developing nations. Pathophysiology is unknown but can be hypothesized as a persistent "on" state as a progression from chronic migraine with increasing central sensitization, but there may be heterogeneity in the underlying pathophysiology. No guidelines exist for treatment of refractory migraine; once all guideline-based treatments are tried, treatment consists of n-of-1 treatment trials paired with non-pharmacologic management. Conclusion Refractory migraine is poorly described diagnostically, its pathophysiology can only be guessed at by extension of chronic migraine, and treatment is more the art than science of medicine. Navigating care of this refractory population will require multidisciplinary care models and an emphasis on future research to answer these unknowns.
Collapse
Affiliation(s)
- Jennifer Robblee
- Department of Neurology, Dignity Health, St Joseph’s Hospital and Medical Center, Lewis Headache Clinic, Barrow Neurological Institute, Phoenix, AZ, United States
| |
Collapse
|
12
|
Macionis V. Chronic pain and local pain in usually painless conditions including neuroma may be due to compressive proximal neural lesion. FRONTIERS IN PAIN RESEARCH 2023; 4:1037376. [PMID: 36890855 PMCID: PMC9986610 DOI: 10.3389/fpain.2023.1037376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 01/12/2023] [Indexed: 02/22/2023] Open
Abstract
It has been unexplained why chronic pain does not invariably accompany chronic pain-prone disorders. This question-driven, hypothesis-based article suggests that the reason may be varying occurrence of concomitant peripheral compressive proximal neural lesion (cPNL), e.g., radiculopathy and entrapment plexopathies. Transition of acute to chronic pain may involve development or aggravation of cPNL. Nociceptive hypersensitivity induced and/or maintained by cPNL may be responsible for all types of general chronic pain as well as for pain in isolated tissue conditions that are usually painless, e.g., neuroma, scar, and Dupuytren's fibromatosis. Compressive PNL induces focal neuroinflammation, which can maintain dorsal root ganglion neuron (DRGn) hyperexcitability (i.e., peripheral sensitization) and thus fuel central sensitization (i.e., hyperexcitability of central nociceptive pathways) and a vicious cycle of chronic pain. DRGn hyperexcitability and cPNL may reciprocally maintain each other, because cPNL can result from reflexive myospasm-induced myofascial tension, muscle weakness, and consequent muscle imbalance- and/or pain-provoked compensatory overuse. Because of pain and motor fiber damage, cPNL can worsen the causative musculoskeletal dysfunction, which further accounts for the reciprocity between the latter two factors. Sensitization increases nerve vulnerability and thus catalyzes this cycle. Because of these mechanisms and relatively greater number of neurons involved, cPNL is more likely to maintain DRGn hyperexcitability in comparison to distal neural and non-neural lesions. Compressive PNL is associated with restricted neural mobility. Intermittent (dynamic) nature of cPNL may be essential in chronic pain, because healed (i.e., fibrotic) lesions are physiologically silent and, consequently, cannot provide nociceptive input. Not all patients may be equally susceptible to develop cPNL, because occurrence of cPNL may vary as vary patients' predisposition to musculoskeletal impairment. Sensitization is accompanied by pressure pain threshold decrease and consequent mechanical allodynia and hyperalgesia, which can cause unusual local pain via natural pressure exerted by space occupying lesions or by their examination. Worsening of local pain is similarly explainable. Neuroma pain may be due to cPNL-induced axonal mechanical sensitivity and hypersensitivity of the nociceptive nervi nervorum of the nerve trunk and its stump. Intermittence and symptomatic complexity of cPNL may be the cause of frequent misdiagnosis of chronic pain.
Collapse
|
13
|
Ipsilateral Limb Extension of Referred Trigeminal Facial Pain due to Greater Occipital Nerve Entrapment: A Case Report. Case Rep Neurol Med 2022; 2022:9381881. [PMID: 36505755 PMCID: PMC9734007 DOI: 10.1155/2022/9381881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 08/17/2022] [Accepted: 11/07/2022] [Indexed: 12/05/2022] Open
Abstract
We report a very rare case of referred pain associated with entrapment of the greater occipital nerve (GON) occurring not only in the ipsilateral hemiface but also in the ipsilateral limb. There is an extensive convergence of cutaneous, tooth pulp, visceral, neck, and muscle afferents onto nociceptive and nonnociceptive neurons in the trigeminal nucleus caudalis (medullary dorsal horn). In addition, nociceptive input from trigeminal, meningeal afferents projects into trigeminal nucleus caudalis and dorsal horn of C1 and C2. Together, they form a functional unit, the trigeminocervical complex (TCC). The nociceptive inflow from suboccipital and high cervical structures is mediated with small-diameter afferent fibers in the upper cervical roots terminating in the dorsal horn of the cervical cord extending from the C2 segment up to the medullary dorsal horn. The major afferent contribution is mediated by the spinal root C2 that is peripherally represented by the greater occipital nerve (GON). Convergence of afferent signals from the trigeminal nerve and the GON onto the TCC is regarded as an anatomical basis of pain referral in craniofacial pain and primary headache syndrome. Ipsilateral limb pain occurs long before the onset of the referred facial pain. The subsequent severe hemifacial pain suggested GON entrapment. The occipital nerve block provided temporary relief from facial and extremity pain. Imaging studies found a benign osteoma in the ipsilateral suboccipital bone, but no direct contact with GON was identified. During GON decompression, severe entrapment of the GON was observed by the tendinous aponeurotic edge of the trapezius muscle, but the osteoma had no contact with the nerve. Following GON decompression, the referred trigeminal and extremity pain completely disappeared. The pain referral from GON entrapment seems to be attributed to the sensitization and hypersensitivity of the trigeminocervical complex (TCC). The clinical manifestations of TCC hypersensitivity induced by chronic entrapment of GONs are diverse when considering the occurrence of extremity pain as well as facial pain.
Collapse
|
14
|
Blake P, ElHawary H, Janis JE. Increasing Collaboration between Headache Medicine and Plastic Surgery in the Surgical Management of Chronic Headache. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4479. [PMID: 36032365 PMCID: PMC9400943 DOI: 10.1097/gox.0000000000004479] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 06/27/2022] [Indexed: 06/15/2023]
Abstract
Introduction Chronic headache is one of the most disabling conditions afflicting humankind. The management of chronic headaches has, to date, been only partially successful. The goal of this paper is to highlight the importance of collaboration between surgeons and headache physicians in treating this condition. Methods We present a narrative review of migraine pathophysiology, its medical and surgical treatment options, and the important role of collaboration between headache physicians and surgeons. Results Migraine headaches can be treated with both medication-based regimens and surgery. Novel medications such monoclonal antibodies directed at the CGRP molecule or its receptor have recently been FDA approved as an effective treatment modality in chronic migraines. However, these medications are associated with a high cost, and there is a paucity in data regarding effectiveness compared to other treatment modalities. The pathophysiology of headache likely exists along a spectrum with peripheral - extracranial and meningeal - factors at one end and central - brain - factors at the other, with anatomic and physiologic connections between both ends. Recent evidence has clearly shown that surgical decompression of extracranial nerves improves headache outcomes. However, appropriate patient selection and preoperative diagnosis are of paramount importance to achieve excellent outcomes. Conclusions Surgeons and headache physicians who are interested in providing treatment for patients with chronic headache should strive to form a close collaboration with each other in order to provide the optimal plan for migraine/headache patients.
Collapse
Affiliation(s)
- Pamela Blake
- From the Headache Center of River Oaks, Houston, Tex
- University of Texas Health Science Center, Houston, Tex
| | - Hassan ElHawary
- Division of Plastic and Reconstructive Surgery, Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Jeffrey E. Janis
- Department of Plastic and Reconstructive Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
| |
Collapse
|
15
|
Bernhoff G, Huhmar HM, Rasmussen-Barr E, Bunketorp Käll L. The Significance of Pain Drawing as a Screening Tool for Cervicogenic Headache and Associated Symptoms in Chronic Fatigue. J Pain Res 2022; 15:2547-2556. [PMID: 36061488 PMCID: PMC9432569 DOI: 10.2147/jpr.s369470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/20/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) present with a broad spectrum of symptoms, including headache. A simple, yet powerful tool – the pain drawing identifies essential aspects such as pain distribution. The aim with this study was to 1) evaluate the significance of pain drawing as a screening tool for cervicogenic headache using a predefined C2 pain pattern, 2) assess whether there was an association between dizziness/imbalance and a C2 pain pattern, and 3) compare subgroups according to the pain drawing with respect to pain characteristics and quality of life. Patients and Methods Pain drawings and clinical data from 275 patients investigated for ME/CFS were stratified into: 1) cervicogenic headache as determined by a C2 pain pattern, 2) headache with no C2 pain pattern, and 3) no headache. For inference logistic regression presented with odds ratios (OR) and 95% confidence intervals (95% CI) and Kruskal–Wallis test were applied. Results One hundred sixteen participants (42%) were stratified to the group for which the pain drawing corresponded to the C2 pain pattern, thus indicating putative cervicogenic origin of the headache. Dizziness/imbalance was strongly associated with a C2 pain pattern; OR 6.50 ([95% CI 2.42–17.40] p ˂ 0.00), whereas this association was non-significant for patients with headache and no C2 pain pattern. Those demonstrating a C2 pain pattern reported significantly higher pain intensity (p = 0.00) and greater pain extent (p = 0.00) than the other groups, and lower health-related quality of life (p = 0.00) than the group with no headache. Conclusion For patients with chronic fatigue who present with a C2 pain pattern (interpreted as cervicogenic headache) the pain drawing seems applicable as a screening tool for signs associated with neuropathic and more severe pain, dizziness and reduced quality of life as detection of these symptoms is essential for targeted treatment.
Collapse
Affiliation(s)
- Gabriella Bernhoff
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institute, Stockholm, Sweden
- ME-Centre, Bragée Clinics, Stockholm, Sweden
- Correspondence: Gabriella Bernhoff, Karolinska Institute, Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Alfred Nobels allé 23 D2, 141 83 Huddinge, Stockholm, Sweden, Tel +46 720 71 33 29, Email
| | | | - Eva Rasmussen-Barr
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institute, Stockholm, Sweden
| | - Lina Bunketorp Käll
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Advanced Reconstruction of Extremities, Sahlgrenska University Hospital/Mölndal, Mölndal, Sweden
| |
Collapse
|
16
|
Chung M, Huh R. Neuromodulation for trigeminal neuralgia. J Korean Neurosurg Soc 2022; 65:640-651. [PMID: 35574582 PMCID: PMC9452392 DOI: 10.3340/jkns.2022.0004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 02/16/2022] [Indexed: 11/27/2022] Open
|
17
|
Brown MG, LaRoque MC, Cole PA. Bony Decompression of a Chronically Painful Intercostal Nerve Yields Immediate and Long-Lasting Pain Relief: A Case Report. JBJS Case Connect 2022; 12:01709767-202206000-00018. [PMID: 37440683 DOI: 10.2106/jbjs.cc.21.00631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
CASE The case of an active 16-year-old adolescent girl who presented with rib malunion and 1 year of unremitting intercostal nerve pain after sustaining multiple rib fractures is presented. She underwent successful bony and soft-tissue decompression of her eighth and ninth intercostal nerves to relieve neurogenic symptoms. CONCLUSION When conservative treatment fails, chronic intercostal nerve pain due to chest wall trauma may be effectively managed with surgical bony decompression of the offending intercostal bundle(s). Anatomic knowledge of the intercostal nerve and a critical history and physical examination were critical for accurate diagnosis and surgical decompression of the patient's intercostal nerve.
Collapse
Affiliation(s)
- Marcel G Brown
- Dartmouth College Geisel School of Medicine, Hanover, New Hampshire
| | - Michael C LaRoque
- Department of Orthopaedic Surgery, University of Minnesota, Regions Hospital, St. Paul, Minnesota
| | - Peter A Cole
- Department of Orthopaedic Surgery, University of Minnesota, Regions Hospital, St. Paul, Minnesota
| |
Collapse
|
18
|
Abstract
PURPOSE OF REVIEW This manuscript aims to review the risks and the current treatments for postdural puncture headache (PDPH). RECENT FINDINGS PDPH is a relatively frequent complication after neuraxial blocks. It is typically orthostatic in nature, presenting as a positional and dull aching or throbbing headache, with added dysregulation of auditory and/or visual signals. Certain characteristics, such as female sex and young age, may predispose patients to the development of PDPH, as may factors such as previous PDPH, bearing down during the second stage of labor, and the neuraxial technique itself. Long-term complications including chronic headache for years following dural puncture have brought into question of the historical classification of PDPH as a self-limiting headache. So far, the underlying mechanism governing PDPH remains under investigation, while a wide variety of prophylactic and therapeutic measures have been explored with various degree of success. In case of mild PDPH, conservative management involving bed rest and pharmacological management should be used as first-line treatment. Nerve blocks are highly efficient alternatives for PDPH patients who do not respond well to conservative treatment. In case of moderate-to-severe PDPH, epidural blood patch remains the therapy of choice. An interdisciplinary approach to care for patients with PDPH is recommended to achieve optimal outcomes.
Collapse
|
19
|
Al-Khazali HM, Younis S, Al-Sayegh Z, Ashina S, Ashina M, Schytz HW. Prevalence of neck pain in migraine: A systematic review and meta-analysis. Cephalalgia 2022; 42:663-673. [PMID: 35166137 DOI: 10.1177/03331024211068073] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Neck pain is a frequent complaint among patients with migraine and seems to be correlated with the headache frequency. Neck pain is more common in patients with chronic migraine compared to episodic migraine. However, prevalence of neck pain in patients with migraine varies among studies. OBJECTIVE To estimate the prevalence of neck pain in patients with migraine and non-headache controls in observational studies. METHODS A systematic literature search on PubMed and Embase was conducted to identify studies reporting prevalence of neck pain in migraine patients. This review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data was extracted by two independent investigators and results were pooled using random-effects meta-analysis. The protocol was registered with PROSPERO (CRD42021264898). RESULTS The search identified 2490 citations of which 30 contained relevant original population based and clinic-based data. Among these, 24 studies provided data eligible for the analysis. The meta-analysis for clinic-based studies demonstrated that the pooled relative frequency of neck pain was 77.0% (95% CI: 69.0-86.4) in the migraine group and 23.2% (95% CI:18.6-28.5) in the non-headache control group. Neck pain was more frequent in patients with chronic migraine (87.0%, 95% CI: 77.0-93.0) compared to episodic migraine (77.0%, 95% CI: 69.0-84.0). Neck pain was 12 times more prevalent in migraine patients compared to non-headache controls and two times more prevalent in patients with chronic migraine compared to episodic migraine. The calculated heterogeneity (I2 values) ranged from 61.3% to 72.0%. CONCLUSION Neck pain is a frequent complaint among patients with migraine. The heterogeneity among the studies emphasize important aspects to consider in future research of neck pain in migraine to improve our understanding of the driving mechanisms of neck pain in a major group of migraine patients.
Collapse
Affiliation(s)
- Haidar Muhsen Al-Khazali
- Danish Headache Center, 70590Rigshospitalet Glostrup, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Samaira Younis
- Danish Headache Center, 70590Rigshospitalet Glostrup, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Zainab Al-Sayegh
- Danish Headache Center, 70590Rigshospitalet Glostrup, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Sait Ashina
- Danish Headache Center, 70590Rigshospitalet Glostrup, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.,Comprehensive Headache Center, Departments of Neurology and Anesthesia, 1859Beth Israel Deaconess Medical Center, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Messoud Ashina
- Danish Headache Center, 70590Rigshospitalet Glostrup, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Henrik W Schytz
- Danish Headache Center, 70590Rigshospitalet Glostrup, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| |
Collapse
|
20
|
Son BC. Decompression of the Greater Occipital Nerve for Occipital Neuralgia and Chronic Occipital Headache Caused by Entrapment of the Greater Occipital Nerve. J Neurol Surg A Cent Eur Neurosurg 2022; 83:461-470. [PMID: 34991172 DOI: 10.1055/s-0041-1739228] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Chronic entrapment of the greater occipital nerve (GON) can not only manifest in typical stabbing pain of occipital neuralgia (ON) but also lead to continuous ache and pressure-like pain in the occipital and temporal areas. However, the effect of GON decompression on these symptoms has yet to be established. We report the follow-up results of GON decompression in typical cases of ON and chronic occipital headache due to GON entrapment (COHGONE). METHODS A 1-year follow-up study of GON decompression was conducted on 11 patients with typical ON and 39 COHGONE patients with GON entrapment. The degree of pain reduction was analyzed using the numerical rating scale-11 (NRS-11) score and percent pain relief before and 1 year after surgery. A success was defined by at least a 50% reduction in pain measured via NRS-11 during the 12-month follow-up. To assess the degree of subjective satisfaction, a 10-point Likert scale was used. Postoperative outcome was also evaluated using the Barrow Neurological Institute (BNI) pain intensity score. The difference in GON decompression between the patients with typical ON and those with COHGONE was studied. RESULTS GON decompression was successful in 43 of 50 patients (86.0%) and percent pain relief was 72.99 ± 25.53. Subjective improvement based on a 10-point Likert scale was 7.9 ± 2.42 and the BNI grade was 2.06 ± 1.04. It was effective in both the ON and COHGONE groups, but the success rate was higher in the ON group (90.9%) than in the COHGONE group (84.6%), showing statistically significant differences in the results based on average NRS-11 score, percent pain relief, subjective improvement, and BNI grades (p < 0.05, independent t-test). CONCLUSION GON decompression is effective in chronic occipital headache and in ON symptoms induced by GON entrapment.
Collapse
Affiliation(s)
- Byung-Chul Son
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Catholic Neuroscience Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| |
Collapse
|
21
|
Robla-Costales J, Rodríguez-Aceves C, Martínez-Benia F, Socolovsky M. State of the Art and Advances in Peripheral Nerve Surgery. Adv Tech Stand Neurosurg 2022; 45:245-283. [PMID: 35976453 DOI: 10.1007/978-3-030-99166-1_8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This review is intended to describe and actualize the basic knowledge of the three basic entities that affect the peripheral nerve system and can be treated by surgery: nerve trauma, chronic nerve compressions, and tumors.Regarding trauma, emphasis is given on the timing of surgery, given the fact that the moment in which the surgery is performed and the employed microsurgical reconstruction technique are the most important factors in the final result. Open lesions with associated nerve injury should be managed with an early exploration carried out before 7 days. Closed injuries are usually deferred, with few exceptions, from 3 to 6 months after the trauma.In turn, chronic compressions require an appropriate clinical, neurophysiological, and imaging diagnosis. Isolated sensory symptoms can be treated actively though without surgery: motor signs like atrophy should be regarded as a sign for immediate surgery, as a deferred treatment might cause an irreversible nerve and muscular damage. Endoscopic approaches are a valuable tool for treatment in selected neuropathies.Finally, nerve tumors demand a thorough preoperative evaluation, as benign tumors are treated in a very different way when compared to malignant lesions. Benign tumors can usually be safely and completely resected without sacrificing the nerve of origin. When malignancy is confirmed, extensive resection to optimize patient survival is the main objective, potentially at the expense of neurological function. This may then be followed by adjuvant radiation and/or chemotherapy, depending on the nature of the tumor and the completeness of resection attained. The role of nerve biopsy remains controversial, and several modern diagnostic techniques might be helpful.
Collapse
Affiliation(s)
| | - Carlos Rodríguez-Aceves
- Neurological Center, The American British Cowdray Medical Center campus Santa Fe, Mexico City, Mexico
| | - Fernando Martínez-Benia
- Department of Neurosurgery, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - Mariano Socolovsky
- Department of Neurosurgery, Hospital de Clínicas, Universidad de Buenos Aires, Buenos Aires, Argentina.
| |
Collapse
|
22
|
Evans AG, Assi PE, Al Kassis S. A Review of the Diagnosis and Management of Headache. JAMA 2021; 326:977. [PMID: 34519805 DOI: 10.1001/jama.2021.11376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Adam G Evans
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Patrick E Assi
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Salam Al Kassis
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| |
Collapse
|
23
|
Lee CI, Son BC. Decompression of the Greater Occipital Nerve for Persistent Headache Attributed to Whiplash Accompanying Referred Facial Trigeminal Pain. World Neurosurg 2021; 155:e814-e823. [PMID: 34509676 DOI: 10.1016/j.wneu.2021.09.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 09/03/2021] [Accepted: 09/04/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Persistent headache attributed to whiplash (PHAW) is defined as a headache that occurs for the first time in close temporal relation to whiplash lasting more than 3 months. We investigated the results of decompression of the greater occipital nerve (GON) in patients with PHAW who presented with referred trigeminal facial pain caused by sensitization of the trigeminocervical complex) along with occipital headache. METHODS A 1-year follow-up study of GON decompression was conducted in 7 patients with PHAW manifesting referred facial trigeminal pain. The degree of pain reduction was analyzed using the numeric rating scale (NRS-11) and percent pain relief before and 1 year after surgery. Success was defined by at least 50% reduction in pain measured via NRS-11. To assess the degree of subjective satisfaction, a 10-point Likert scale was used. Clinical characteristics of headache and facial pain and surgical findings were studied. RESULTS GON decompression was effective in all 7 patients with PHAW manifesting referred trigeminal pain, with a percent pain relief of 83.06 ± 17.30. The pain had disappeared in 3 of 7 patients (42.9%) within 6 months and no further treatment was needed. Patients' assessment of subjective improvement based on a 10-point Likert scale was 7.23 ± 1.25. It was effective in both occipital and facial pain. CONCLUSIONS Although chronic GON entrapment itself is an individual constitutional issue, postwhiplash inflammatory changes seem to trigger chronic occipital headaches in GON distribution and unexplained referred trigeminal pain caused by sensitization of the trigeminocervical complex.
Collapse
Affiliation(s)
- Chang-Ik Lee
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - Byung-Chul Son
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea; Catholic Neuroscience Institute, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea.
| |
Collapse
|
24
|
Ong JJY, Chan ACY, Bharatendu C, Teoh HL, Chan YC, Sharma VK. Headache Related to PPE Use during the COVID-19 Pandemic. Curr Pain Headache Rep 2021; 25:53. [PMID: 34129112 PMCID: PMC8203491 DOI: 10.1007/s11916-021-00968-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2021] [Indexed: 01/10/2023]
Abstract
PURPOSE OF REVIEW Personal protection equipment (PPE)-associated headache is an unusual secondary headache disorder that predominantly occurs in healthcare workers as a consequence of the donning of protective respirators, face masks and/or eyewear. The appreciation of this entity is important given the significant ramifications upon the occupational health of healthcare workers and could additionally have an impact on persons living with pre-existing headache disorder(s). RECENT FINDINGS There has been a renewed interest and recognition of PPE-associated headaches amongst healthcare professionals, largely brought about by the ongoing COVID-19 pandemic which has besieged healthcare systems worldwide. De novo PPE-associated headaches may present with migrainous or tension-type features and can be viewed as a subtype of external compression headache. The prognosis of the disorder is generally favourable, given that most headaches are short-lived without long-term sequalae. Several aetiologies have been postulated to account for the development of these headaches. Notably, these headaches can affect the occupational health and work performance of healthcare workers. In this review, we discuss the epidemiology, clinical characteristics, probable etiopathogenesis, management and prognosis of PPE-associated headaches in the context of the COVID-19 pandemic. Future directions for research and PPE development are proposed.
Collapse
Affiliation(s)
- Jonathan J Y Ong
- Division of Neurology, National University Hospital and Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 10, 1E Kent Ridge Road, Singapore, 119228, Singapore.
| | - Amanda C Y Chan
- Division of Neurology, National University Hospital and Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 10, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Chandra Bharatendu
- Division of Neurology, National University Hospital and Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 10, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Stead Family Department of Pediatrics, Division of Medical Genetics and Genomics, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Hock Luen Teoh
- Division of Neurology, National University Hospital and Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 10, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Yee Cheun Chan
- Division of Neurology, National University Hospital and Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 10, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Vijay K Sharma
- Division of Neurology, National University Hospital and Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 10, 1E Kent Ridge Road, Singapore, 119228, Singapore
| |
Collapse
|
25
|
Zaheer R, Khan M, Tanveer A, Farooq A, Khurshid Z. Association of Personal Protective Equipment with De Novo Headaches in Frontline Healthcare Workers during COVID-19 Pandemic: A Cross-Sectional Study. Eur J Dent 2020; 14:S79-S85. [PMID: 33368069 PMCID: PMC7775222 DOI: 10.1055/s-0040-1721904] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES This study aimed to determine the association of personal protective equipment (PPE) usage with new-onset headaches and exacerbation of pre-existing headache disorders among healthcare workers at the frontlines during coronavirus disease 2019 (COVID-19) pandemic. MATERIALS AND METHODS A descriptive cross-sectional survey was conducted across Pakistan in June-July 2020. The study was approved by Ethical Committee, Armed Forces Institute of Dentistry, Rawalpindi (IRB form no.905/Trg-ABP 1K2). A qualitative questionnaire was developed and was shared via different social networks. The questionnaire was closed when 241 responses were received. STATISTICAL ANALYSIS Descriptive analysis was performed on demographic data. Chi-squared analysis was performed between demographic data and PPE-usage patterns among participants with or without de novo headaches. Univariable and multivariable logistic regression models were used to compare variables with the development of new-onset headaches. Chi-squared test was also performed between demographic data and other factors that may be causing new-onset headaches. A p-value < 0.05 was considered significant. RESULTS A total of 241 healthcare workers participated, of which 68 participants (28.2%) reported de novo headaches since the start of the pandemic. Incidence of pre-existing headaches (odds ratio [OR] = 1.91; 95% confidence interval [CI]: 0.99-0.37; p = 0.049) was associated with new-onset headaches. Post hoc multivariable logistic regression analysis stated that incidence of pre-existing headaches (OR = 1.88; 95% CI: 0.94-3.78; p = 0.75) and age (OR = 2.21; 95% CI: 0.47-10.33; p = 0.36) was independently associated with new-onset PPE-induced headaches but was not statistically significant. Chi-squared analysis showed a statistically significant relationship between other factors (sleep deprivation, emotional stress, etc.) and department of activity, gender, and occupation (p < 0.05). CONCLUSION Healthcare workers with previous history of pre-existing headaches were found to be more susceptible to PPE-induced headaches during COVID-19 pandemic. However, age and the department where the healthcare workers performed may also be risk factors.
Collapse
Affiliation(s)
- Rumeesha Zaheer
- Orthodontics Department, Armed Forces Institute of Dentistry, Combined Military Hospital, Rawalpindi, Pakistan
| | - Maheen Khan
- Prosthodontics Department, Khyber College of Dentistry, Peshawar, Pakistan
| | - Ahmed Tanveer
- National University of Medical Sciences, Rawalpindi, Pakistan
| | - Amal Farooq
- National University of Medical Sciences, Rawalpindi, Pakistan
| | - Zohaib Khurshid
- Department of Prosthodontics and Dental Implantology, College of Dentistry, King Faisal University, Al Ahsa, Saudi Arabia
| |
Collapse
|
26
|
Peripheral Occipital Nerve Decompression Surgery in Migraine Headache. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3019. [PMID: 33173659 PMCID: PMC7647655 DOI: 10.1097/gox.0000000000003019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 06/08/2020] [Indexed: 01/20/2023]
Abstract
Migraine headache in the occipital region is characterized by a recurrent pain of moderate to severe intensity. However, the diagnosis can be difficult because of the multitude of symptoms overlapping with similar disorders and a pathophysiology that is not well-understood. For this reason, the medical management is often complex and ineffective.
Collapse
|
27
|
Rodríguez-Almagro D, Achalandabaso-Ochoa A, Molina-Ortega FJ, Obrero-Gaitán E, Ibáñez-Vera AJ, Lomas-Vega R. Neck Pain- and Unsteadiness-Inducing Activities and their Relationship to the Presence, Intensity, Frequency, and Disability of Headaches. Brain Sci 2020; 10:brainsci10070425. [PMID: 32635312 PMCID: PMC7407814 DOI: 10.3390/brainsci10070425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/26/2020] [Accepted: 07/01/2020] [Indexed: 01/01/2023] Open
Abstract
(1) Background: Headache is a significant public health problem. Despite the association between headache and neck pain, little is known about the relationships among specific activities that generate neck pain and headache. The aim of this study was to identify the specific activities that result in neck pain and unsteadiness, and determine how they are linked to headache in university students. (2) Methods: One hundred and six patients with physician-diagnosed headache and 92 healthy university students completed surveys assessing demographics; the presence, frequency, intensity, and disability of headaches; and activities generating neck pain and unsteadiness. (3) Results: The presence of headache was related to female gender (p = 0.001), neck pain when reading or watching television (p = 0.024), and unsteadiness when moving the head (p = 0.005). Headache-related disability was associated with intensity of neck pain (p < 0.001), neck pain when reading or watching television (p = 0.033), and stumbling (p < 0.001). Headache frequency was related to smoking (p = 0.004), the duration of neck pain-associated symptoms (p = 0.047), and neck pain when driving (p = 0.039). Intensity of headache was associated with female gender (p = 0.002), smoking (p = 0.013), and neck pain-related sleep alterations (p = 0.024). (4) Conclusions: Female gender, smoking, neck pain, and unsteadiness when moving the head are factors related to headache in university students.
Collapse
|
28
|
Burstein R, Blumenfeld AM, Silberstein SD, Manack Adams A, Brin MF. Mechanism of Action of OnabotulinumtoxinA in Chronic Migraine: A Narrative Review. Headache 2020; 60:1259-1272. [PMID: 32602955 PMCID: PMC7496564 DOI: 10.1111/head.13849] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 04/20/2020] [Accepted: 05/04/2020] [Indexed: 12/15/2022]
Abstract
Objective To review the literature on the mechanism of action of onabotulinumtoxinA in chronic migraine. Background OnabotulinumtoxinA is a chronic migraine preventive treatment that significantly reduces headache frequency. The traditional mechanism described for onabotulinumtoxinA – reducing muscle contractions – is insufficient to explain its efficacy in migraine, which is primarily a sensory neurological disease. Methods A narrative literature review on the mechanism of action of onabotulinumtoxinA in chronic migraine. Results Following injection into tissues, onabotulinumtoxinA inhibits soluble N‐ethylmaleimide‐sensitive fusion attachment protein receptor (SNARE)‐mediated vesicle trafficking by cleaving one of its essential proteins, soluble N‐ethylmaleimide‐sensitive fusion attachment protein (SNAP‐25), which occurs in both motor and sensory nerves. OnabotulinumtoxinA inhibits regulated exocytosis of motor and sensory neurochemicals and proteins, as well as membrane insertion of peripheral receptors that convey pain from the periphery to the brain, because both processes are SNARE dependent. OnabotulinumtoxinA can decrease exocytosis of pro‐inflammatory and excitatory neurotransmitters and neuropeptides such as substance P, calcitonin gene‐related peptide, and glutamate from primary afferent fibers that transmit nociceptive pain and participate in the development of peripheral and central sensitization. OnabotulinumtoxinA also decreases the insertion of pain‐sensitive ion channels such as transient receptor potential cation channel subfamily V member 1 (TRPV1) into the membranes of nociceptive neurons; this is likely enhanced in the sensitized neuron. For chronic migraine prevention, onabotulinumtoxinA is injected into 31‐39 sites in 7 muscles of the head and neck. Sensory nerve endings of neurons whose cell bodies are located in trigeminal and cervical ganglia are distributed throughout the injected muscles, and are overactive in people with migraine. Through inhibition of these sensory nerve endings, onabotulinumtoxinA reduces the number of pain signals that reach the brain and consequently prevents activation and sensitization of central neurons postulated to be involved in migraine chronification. Conclusion OnabotulinumtoxinA likely acts via sensory mechanisms to treat chronic migraine.
Collapse
Affiliation(s)
- Rami Burstein
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Andrew M Blumenfeld
- The Headache Center of Southern California, The Neurology Center, Carlsbad, CA, USA
| | - Stephen D Silberstein
- Department of Neurology Jefferson Headache Center, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Mitchell F Brin
- Allergan, Inc., Irvine, CA, USA.,University of California, Irvine, CA, USA
| |
Collapse
|
29
|
Ong JJY, Bharatendu C, Goh Y, Tang JZY, Sooi KWX, Tan YL, Tan BYQ, Teoh HL, Ong ST, Allen DM, Sharma VK. Headaches Associated With Personal Protective Equipment - A Cross-Sectional Study Among Frontline Healthcare Workers During COVID-19. Headache 2020; 60:864-877. [PMID: 32232837 DOI: 10.1111/head.13811] [Citation(s) in RCA: 251] [Impact Index Per Article: 62.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 03/29/2020] [Accepted: 03/29/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is an emerging infectious disease of pandemic proportions. Healthcare workers in Singapore working in high-risk areas were mandated to wear personal protective equipment (PPE) such as N95 face mask and protective eyewear while attending to patients. OBJECTIVES We sought to determine the risk factors associated with the development of de novo PPE-associated headaches as well as the perceived impact of these headaches on their personal health and work performance. The impact of COVID-19 on pre-existing headache disorders was also investigated. METHODS This is a cross-sectional study among healthcare workers at our tertiary institution who were working in high-risk hospital areas during COVID-19. All respondents completed a self-administered questionnaire. RESULTS A total of 158 healthcare workers participated in the study. Majority [126/158 (77.8%)] were aged 21-35 years. Participants included nurses [102/158 (64.6%)], doctors [51/158 (32.3%)], and paramedical staff [5/158 (3.2%)]. Pre-existing primary headache diagnosis was present in about a third [46/158 (29.1%)] of respondents. Those based at the emergency department had higher average daily duration of combined PPE exposure compared to those working in isolation wards [7.0 (SD 2.2) vs 5.2 (SD 2.4) hours, P < .0001] or medical ICU [7.0 (SD 2.2) vs 2.2 (SD 0.41) hours, P < .0001]. Out of 158 respondents, 128 (81.0%) respondents developed de novo PPE-associated headaches. A pre-existing primary headache diagnosis (OR = 4.20, 95% CI 1.48-15.40; P = .030) and combined PPE usage for >4 hours per day (OR 3.91, 95% CI 1.35-11.31; P = .012) were independently associated with de novo PPE-associated headaches. Since COVID-19 outbreak, 42/46 (91.3%) of respondents with pre-existing headache diagnosis either "agreed" or "strongly agreed" that the increased PPE usage had affected the control of their background headaches, which affected their level of work performance. CONCLUSION Most healthcare workers develop de novo PPE-associated headaches or exacerbation of their pre-existing headache disorders.
Collapse
Affiliation(s)
- Jonathan J Y Ong
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Chandra Bharatendu
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yihui Goh
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Jonathan Z Y Tang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Emergency Medicine, National University Hospital, Singapore, Singapore
| | - Kenneth W X Sooi
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Yi Lin Tan
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Benjamin Y Q Tan
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hock-Luen Teoh
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Shi T Ong
- Department of Emergency Medicine, National University Hospital, Singapore, Singapore
| | - David M Allen
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Division of Infectious Diseases, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Vijay K Sharma
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| |
Collapse
|