Neck headache

Introduction Headache caused by cervical bone lesions and soft tissue manipulation is called cervical headache or referred to as neck headache. In 1995, Bogduk pointed out that cervical degeneration and muscle spasm are the direct causes of cervicogenic headache. It is believed that cervicogenic headache can also be called post-brain nerve headache. Recently, some scholars have referred to cervicogenic headache as high radiculopathy. Cervical headache can be divided into neurogenic pain and myogenic pain according to different parts of the nerve root. The sensory root fibers of the nerve root are stimulated to cause neuropathic pain, while the ventral motor nerve roots are stimulated with myogenic pain.

Cause

Pathogenesis of cervicogenic headache:

Cervical headache can be divided into neurogenic pain and myogenic pain according to different parts of the nerve root. The sensory root fibers of the nerve root are stimulated to cause neuropathic pain, while the ventral motor nerve roots are stimulated with myogenic pain.

(1) The relationship between anatomical basis and cervicogenic headache:

The high cervical nerve includes the 1st to 4th cervical nerves and is closely related to headache. It has been thought that the first cervical nerve is a motor nerve and does not contain sensory fibers. In recent years, it has been found that the first cervical nerve sends a posterior branch of the first cervical nerve above the posterior arch of the atlas, distributed to the posterior rectus muscle, the upper and lower oblique muscles, which are rich in sensory nerve fibers.

The second cervical nerve emerges from the interlaminar space, and the posterior branch divides the medial branch, the lateral branch, the upper branch, the lower branch, and the inferior oblique branch. The medial branch and the fibers from the third cervical nerve together form the occipital nerve, the occipital nerve and the auricular nerve, which are the main nerves that conduct otogenic headache. The lateral branch is distributed to the longest muscle of the head, the head muscles and the head half of the spine muscles. In the transverse process of the internodal nodule, the upper branch of the posterior branch of the second cervical nerve is connected with the posterior branch of the first cervical nerve, and the lower branch is connected to the second and third cervical facet joints and the posterior branch of the third cervical nerve. Connected. The posterior branches of the first, second, and third cervical nerves are connected by a traffic branch to form a nerve ring (or called the superior cervical plexus, or the posterior cervical plexus of the Cruveihier).

The third cervical nerve intervertebral foramen sends a posterior branch of the third cervical nerve behind the vertebral artery, and the medial branch is distributed to the multifidus muscle, and the lateral branch is distributed to the longest muscle of the head, the head muscle, and the head half of the spine muscle. The branches of these nerves are close to the vertebral artery through the occipital foramen into the anterior corner of the cranial cavity, which is easily stimulated and damaged by the vertebral processes and muscles at the attachment. When the nerves are oppressed and stimulated, there may be a loss of sensation, an allergy or a loss of sensation on the scalp.

The terminal fibers from the olfactory nerve, the facial nerve, the glossopharyngeal nerve, the vagus nerve, and the afferent branch of the trigeminal nerve are associated with the afferent fibers of the posterior root of the first to third cervical nerves in the posterior horn of the cervical spinal cord 1 to 2. The sensory range of these cervical nerves can extend forward to the forehead and lower part of the sac, and can cause head pain, tinnitus, eye swelling, and changes in smell and taste, such as sinus, ear or eye, when stimulated by compression or inflammation. The performance of the disease.

Most of the path of the first, second, and third cervical nerves after leaving the spinal canal is in soft muscle tissue. Inflammation, ischemia, injury, compression, and even inappropriate massage of soft tissue can affect the function of the nerve and cause cervicogenic headache.

(B), cervical vertebrae and intervertebral disc degeneration caused by intervertebral foramen stenosis:

Cervical intervertebral disc degeneration or protrusion after "fibrosis" and become "hard", and later with the tissue repair calcification can form bone hyperplasia. The vertebral bodies with bone hyperplasia are close to each other, and the lateral hook joints are also close to each other, losing the normal relationship of the articular surface and deforming the intervertebral foramen. The intervertebral foramen are violated, and the intervertebral foramen are occupied by voids, which can cause pain and neurological dysfunction. The size and shape of the intervertebral foramen depend to a large extent on the integrity of the intervertebral disc.

When the spine is in a normal resting state, the normal intervertebral disc can maintain the separation of the vertebral body and the posterior joint, so that the intervertebral foramen remain intact. When the neck is active, the disc is deformed as it slides over the other vertebral body. Normal intervertebral discs are allowed to deform and recover within physiological limits. When the disc is protruded, whether it is static or dynamic, it can affect the relationship between the parts of the adjacent vertebrae and change the size and shape of the intervertebral foramen. At this time, the nerves and blood vessels passing through the intervertebral foramen can be stimulated by compression, pulling, angulation, and inflammation.

(C), non-bacterial inflammation caused by cervical disc degeneration and protrusion:

Cervical intervertebral disc degeneration, protrusion, intervertebral disc material release can directly cause non-bacterial inflammation, edema; due to normal conditions, adult aortic disc avascular is immune immunization area, immune system, intervertebral disc material is foreign body and produce immunoreactive inflammation, causing Cervical discogenic radiculitis. In addition to the direct production of root pain, the release of inflammatory mediators at the distal end, causing inflammation of the soft tissue in the distribution area can also cause pain, which is a mechanism for some patients with refractory cervicogenic headache.

(4), muscle spasm:

Cervical headache can also occur in the neck muscle tissue. On the other hand, the nerve root, especially the ventral motor nerve root (anterior root) can cause reflex neck muscle spasm when it is compressed or inflammatory. On the other hand, Persistent muscle chronic spasm causes tissue ischemia, and metabolites accumulate in muscle tissue. The end products of metabolism cause fasciitis, produce pain, and directly stimulate the nerve trunk and nerve endings that pass through the soft tissue to produce pain.

Working long hours at the desk, the muscles continue to contract to maintain the posture, reduce muscle supply, secondary tendons, and ligaments, myofascial susceptibility to damage; lengthy and boring mental or physical labor, in all parts of the body It is the most common cause of cervical nerve-muscle tension, which is a common cause of cervicogenic headache in adolescents.

an examination

Related inspection

Cerebrospinal fluid neuropeptide-based cervical spine CT examination of spine MRI

Clinical manifestations include headache, head and neck tilt to one side, head and neck stiffness and neck limitation, lower body chills, especially lower limbs, headache with facial or chest sweats, dizziness, and dizziness. Attack, episode, typical trigeminal neuralgia.

X-ray film, CT examination, magnetic resonance examination, cranial Doppler examination, dynamic electrocardiogram.

Differential diagnosis

Post-traumatic headache: Post-traumatic headache is divided into acute and chronic, and head trauma is usually accompanied by concussion. Acute traumatic headache may result in loss of consciousness or short-term memory loss. It usually occurs within 14 days after waking, lasting for about 1-2 months, showing headache-like headache, accompanied by nausea, vomiting, gastrointestinal symptoms and dizziness. There is no obvious characteristic of headache after chronic trauma, local tenderness, with depressive symptoms, tinnitus or emotional changes. Post-traumatic headache is associated with cerebral vasomotor regulation disorder and a certain degree of cerebrospinal fluid circulation, and mental and psychological factors also play an important role.

Occipital neuralgia: occurs in the occipital occipital and occipital small nerve distribution areas, local nerves have inflammatory reactions, and occipital neuralgia can also be induced when tumors or cervical spondylosis occur adjacent to the back of the pillow. Mainly for post-headache, generally persistent pain, and may involve adjacent parts such as the neck and the back of the ear, local hyperalgesia, but also paroxysmal tingling, tenderness in the affected area.

Headaches associated with vascular disease: About 30% of headache patients are associated with two conditions: 1 transient transient ischemia, especially in the posterior cerebral artery; 2 carotid or posterior cerebral artery, basilar artery, vertebral artery Such as stenosis and obstruction, easy to occur when there is insufficient blood supply or ischemia. A moderately persistent, fluctuating headache occurs in the corresponding part of the vascular disease.

Headache caused by intracranial diseases: The main causes are: 1 intracranial hematoma, all awake patients due to craniocerebral hemorrhage, increased intracranial pressure, can have severe headache, usually accompanied by a history of hypertension or trauma; 2 intracranial space Sexual lesions, the location of the headache is related to the location of the space-occupying lesion; 3 acute epidural or subdural hematoma, the degree of headache is consistent with the increase of intracranial pressure when the patient is awake. Headache may be accompanied by systemic symptoms, such as increased pulse rate and sweating; 4 subarachnoid hemorrhage can occur suddenly severe headache, accompanied by physical weight loss; if the system, venous rupture, usually within 60 minutes after the rupture of headache With vomiting, slow consciousness and stiff neck.

Cervical-derived headache: Cervical headache is the most common organic headache in the clinic. It is often laborious, limited, cervical pain or cervical vertebrae tenderness. Patients with longer headaches have more pain in the head. There is tenderness, and when there is a headache, there are often symptoms of eye discomfort.

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