Hyperalgesia or hypoalgesia below the top of the ear line to the hairline

Introduction The clinical manifestations of occipital neuralgia are acupuncture-like, knife-cut or burning-like pain on one or both sides of the occipital or occipital part. The examination shows that there is tenderness and occipital at the exit of the large nerve (wind pool). The nerve distribution area (C2-3) is hyperalgesia or hypothyroidism below the ear line to the hairline.

Cause

(l) Cervical disease: cervical vertebrae hyperplasia is the most common cause. A few may be cervical tuberculosis, rheumatoid spondylitis or metastatic cancer.

(2) intraspinal lesions: upper cervical spinal cord tumor, anti-macroscopic tumor, adhesive spinal arachnoiditis, syringomyelia and so on.

(3) Congenital malformation of the occipital occipital region: skull base depression, occipital large hole stenosis, sacral occipital fusion, atlantoaxial dislocation, upper cervical vertebral body insufficiency (fusion), cerebellar tonsil sacral sac.

(4) Injury: ligament injury of the suboccipital joint, anterior and posterior arch fracture of the atlas, and subluxation of the neck and neck injury.

an examination

Related inspection

Ear examination Otolaryngology CT examination

1. There is often a history of cold, infection or "pillowing" before illness.

2. Acute or subacute onset, manifested as tingling, drilling or jumping pain on one or both sides of the neck.

3. The area innervated by the occipital nerve feels allergic or diminished. The tenderness at the exit of the occipital nerve is obvious and can be radiated to the top of the same side.

4. A small number of cases still have cervical spondylosis or symptoms of cervical and thoracic nerve root inflammation.

Differential diagnosis

Differential diagnosis of hyperalgesia or hypotension below the ear line to the hairline:

1, trigeminal neuralgia

More often after the age of 40, the female is slightly more than the male. The pain site is limited to the trigeminal nerve distribution area, and the second and third branches are most common, mostly unilateral, and can be limited to one, or multiple branches at the same time. The upper part of the lower lip above the lower lip, the nose, the mouth, the door gear, the big tooth, the buccal tongue, etc. are most sensitive, and can be induced by slight stimulation, so it has the name of trigger point or folding point. The nature of the pain is a short-term episode of severe pain, which is lightning, knife cutting, burning, tearing pain, severe cases with side muscle reflex convulsions, no aura before pain. Each episode lasts from a few seconds to 1-2 minutes, sudden onset, intermittent period is completely normal, several times a day, dozens of times or even hundreds of times, showing a chronic progressive aggravation, often affecting daily life, patients rarely self-healing. Pain is often induced by washing, eating, talking, etc. Therefore, patients are afraid of painful episodes and are reluctant to wash their faces, brush their teeth, and eat. Therefore, facial and oral hygiene are poor, and their depression and complexion are paralyzed. Some chronic patients may develop nutritional disorders, such as rough skin on the face and slight loss of local pain. Imaging studies can help diagnose other secondary trigeminal neuralgia.

2, sphenopalatine ganglion pain

There are three kinds of nerve components in the sphenopalatine ganglion, which are parasympathetic nerve root, sympathetic nerve root and sensory nerve root. Nerve distribution in the eyelids, lacrimal gland, sphenoid sinus, posterior sinus, maxillary sinus, nasal mucosa, and oral mucosa, upper gums, pharynx, etc., the general sensation of the mucosa in this area, glandular secretion, lacrimal gland secretion and Vascular movement.

Chrysalis neuralgia occurs mostly in adults aged 30-50 years, and is more common in women. It manifests as paroxysmal pain in the lower half of the affected side. The pain is deep and diffuse, often starting from the back of the nose, the eye and the upper jaw, and then extending to the upper palate, the gums, the ankle, the jaw, the tongue, and even the The same side of the occipital part or neck and shoulders spread, the pain is more severe, such as electric shock, knife cutting, acupuncture or burning, it is unbearable, often accompanied by facial flushing, conjunctival hyperemia, photophobia, nasal mucosal congestion, nasal congestion, Autonomic symptoms such as salivation and salivation.

Stimuli such as emotions, intense light, and loud sounds can induce pain or exacerbate pain. Each pain lasts for a few minutes to a few hours or even a few days and is recurrent. Some patients have increased seizures during menstruation. The duration of the interval is variable, and the performance is normal, or mild dull pain and paresthesia remain within a few hours, or mild dull pain and paresthesia remain within a few hours. There were no obvious positive signs during the examination. Some patients may have tenderness in the eyelids, nasal roots and mastoids. Individual patients may show signs of Horner's sign on the affected side, increased brachial artery fluctuations or swelling of the same side and hyperesthesia. Stimulation of the posterior mucosa of the middle turbinate can induce pain.

According to the deep facial pain in the lower half of the side, it is often accompanied by neurological symptoms such as nasal congestion, salivation, and tearing. The following auxiliary examination can confirm the diagnosis:

(1) X-ray examination Some patients have sinusitis changes. (2), tetracaine test positive, that is, after the sphenopalatine ganglion - upper turbinate smear, clinical symptoms can be alleviated after a few minutes. (3) The sphenopalatine ganglion closure can be diagnosed by reducing or alleviating pain.

3, wing tube neuralgia

For the paroxysmal side of the nose, face, eyelids, ears and neck and shoulder pain, often accompanied by paranasal sinusitis. More common in adult women, manifested as unilateral episodes of nasal, eyelid, ear and facial pain, can be transmitted to the head, neck, shoulders, more nights. Often accompanied by symptoms of sinusitis. According to the clinical manifestations, it is effective to block the sphenopalatine ganglion without 0.1%-0.3% tetracaine or 0.25%-0.5% lidocaine.

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