Chronic pain in the headrest

Introduction Occipital neuralgia refers to the pain in the area of the posterior occipital occipital nerve and the occipital small nerve. The occipital and neck sensation is dominated by the first, second, and third pairs of cervical nerves, and the posterior branch of the second cervical nerve constitutes the occipital nerve. The medial line from the midpoint of the mastoid and the posterior midline of the first cervical vertebra is deep. Shallow, distributed in the posterior occiput is equivalent to the part of the external ear canal after the head and neck are connected. The anterior branch of the third cervical nerve constitutes the occipital small nerve and the auricular nerve. The occipital nerves are mainly distributed in the upper part of the auricle and the skin outside the occipital. The large ear nerves are mainly distributed in the anterior and posterior parts of the lower auricle, the surface of the parotid gland and the mandibular angle. When the three nerves are involved, it can cause pain in the posterior occipital and neck, and often occurs in the form of neuralgia. Because the posterior root of the first cervical nerve is generally small, the posterior occipital and neck pain caused by the upper cervical spinal nerve disease is collectively called occipital neuralgia. Frequent occipital pain is mostly associated with insufficient blood supply to the vertebral basilar artery, and the cause of it is mainly cervical spondylosis.

Cause

The basic pathological change of cervical spondylosis is the degeneration of the intervertebral disc. The cervical vertebra is located between the skull and the thorax. The cervical disc has frequent activities under load-bearing conditions and is susceptible to excessive micro-injury and strain.

The main pathological changes are: early cervical disc degeneration, decreased water content of the nucleus pulposus and fibrous swelling and thickening of the annulus fibrosis, followed by glassy degeneration and even rupture. After cervical disc degeneration, the pressure resistance and tensile strength are reduced. When subjected to the gravity of the skull and the pulling force of the muscles of the head and chest, the degenerated disc can undergo localized or extensive bulging to the periphery, narrowing the intervertebral disc space, overlapping the articular processes, dislocation, and the longitudinal diameter of the intervertebral foramen. Become smaller. As the traction resistance of the intervertebral disc becomes weaker, when the cervical vertebra moves, the stability between adjacent vertebrae decreases and the intervertebral instability occurs, the mobility between the vertebral bodies increases and the vertebral body has a slight slippage, which then appears Bone hyperplasia of the posterior facet joint, hook joint and lamina, degeneration of the ligamentum flavum and ligament, cartilage and ossification.

Because the cervical disc bulges around, the surrounding tissues (such as the anterior and posterior longitudinal ligaments) and the vertebral periosteum can be picked up, and a gap is formed between the vertebral body and the protruding intervertebral disc and the ligament tissue that is picked up. The gap ", in which the accumulation of tissue fluid, coupled with the bleeding caused by the micro-damage, makes this bloody fluid mechanized and then calcified, ossified, thus forming the epiphysis. The relaxation of the anterior and posterior ligaments of the vertebral body makes the cervical spine unstable, which increases the chance of trauma and gradually increases the callus. The epiphysis together with the bulging annulus fibrosus, the posterior longitudinal ligament and the edema or fibrous scar tissue caused by the traumatic reaction, forming a mixture in the spinal canal at the site corresponding to the intervertebral disc, may exert an oppressive effect on the spinal nerve or the spinal cord. The epiphysis of the hook joint can protrude from the anterior to the posterior to the intervertebral foramen to compress the nerve root and the vertebral artery. The epiphysis of the anterior border of the vertebral body generally does not cause symptoms, but there are reports of such anterior epiphysis affecting swallowing or hoarseness in the literature. After the spinal cord and nerve roots are compressed, they are only functional changes at the beginning. If the pressure is not relieved in time, it will gradually produce irreversible changes. Therefore, if non-surgical treatment is ineffective, surgery should be performed promptly.

an examination

Related inspection

Brain CT examination EEG examination

The main points of diagnosis of occipital neuralgia are as follows:

1. The patient has the pain characteristics described above.

2. The pain-reducing area in the innervation area.

3. At the time of examination, there was tenderness and radiation pain at the transverse nerves of the 2nd and 3rd cervical vertebrae involved in the affected nerve.

4. Head and neck movements can be an inducement.

5. The occipital nerve block lags behind the pain.

The occipital nerve must be differentiated from occipital pain resulting from the atlantoaxial or superior vertebral joints, or from the trigger point of the neck muscle attachment point.

Differential diagnosis

First, nerve root type cervical spondylosis needs to be identified with the following diseases

1. Cervical rib and anterior scalene muscle syndrome: The patient is younger, mainly characterized by dry compression under the brachial plexus, numbness of the medial extremities, atrophy of the intermuscular muscles and interosseous muscles. Because the subclavian artery is often compressed at the same time, the affected limb is pale and cool, and the radial artery beats weakened or disappeared. The Adson test (head turned to the affected side, temporary aspiration after deep inhalation, brachial artery beat weakened or disappeared) was positive. The neck film can confirm the neck ribs.

2. Intraspinal extramedullary subdural tumors, intervertebral foramen and peripheral neurofibromatosis, and tumors near the lung tip (Pancoast tumor) can cause upper limb pain. Cervical radiographs may reveal signs of lesions in the spinal canal and enlargement of the intervertebral foramen without cervical degenerative changes. CT or MRI can directly display tumor images, and Pancoast tlamor patients are also accompanied by Horner's syndrome.

3. Neuropathic muscle atrophy: often involving the C5 distribution area, causing severe pain, shoulder muscle weakness and atrophy. However, the sensory disorder is mild, the symptoms often relieved quickly, and generally do not involve the neck.

4. angina pectoris: pain can be radiated to the upper limbs and shoulders and neck, but mostly episodes, oral nitroglycerin tablets can be relieved, patients have a history of coronary heart disease, generally not difficult to identify.

5. Tendon sleeve syndrome: mainly manifested as shoulder abduction weakness and abduction more than 30. In the later pain, there is tenderness in the tendon, which is different from nerve root pain.

6. Rheumatic polymyalgia: similar to brachial plexus neuralgia, but without dyskinesia.

Second, cervical spondylosis should be identified with the following diseases

1. Amyotrophic lateral sclerosis: mainly with spastic quadriplegia, no sensory disturbance, and often invades the medulla and causes the lower cranial nerve symptoms.

2. Multiple sclerosis: Symptoms of brain and spinal cord often occur at the same time, and bladder dysfunction occurs before limb dyskinesia.

3. Intraspinal tumor: can occur at any age, the symptoms develop faster. Various imaging examinations are helpful for identification.

4. Spiral stenosis: mainly manifested as sensory disturbances, and dyskinesias appear later. MRI can clearly show the thickening of the central canal of the spinal cord.

Cervical spondylosis of vertebral artery type is relatively rare, and it needs to be differentiated from vertebrobasilar insufficiency caused by other causes, such as vertebral atherosclerosis and dysplasia. Vertebral angiography is the most reliable method of identification.

The symptoms of cervical spondylosis are very rich, diverse and complex. Most patients begin to have milder symptoms, which gradually worsen later, and some of them have more severe symptoms. This is related to the type of cervical spondylosis, but often the type is simple, with one type as the main cum and one to several types mixed together, called mixed cervical spondylosis, so the symptoms are very rich and diverse. complicated.

Its main symptoms are sore head, neck, shoulders, back, arms, neck and neck, and limited mobility. Neck and shoulder pain can be radiated to the head and upper parts of the head, some with dizziness, house rotation, severe with nausea and vomiting, bedridden, a few can have dizziness, tripping. Some of the face is hot, and sometimes sweating is abnormal. The shoulders and back are heavy, the upper limbs are weak, the fingers are numb, the skin of the limbs is weakened, the grip is weak, and sometimes the unconscious grip falls. Other patients have weak limbs, unstable walking, numb feet, and feeling like walking cotton when walking. When cervical spondylosis involves sympathetic nerves, dizziness, headache, blurred vision, dilated eyes, dry hair, open eyes, tinnitus, ear plugs, balance disorders, tachycardia, palpitation, chest tightness, There are even symptoms such as flatulence. A small number of people have large, urinary out of control, sexual dysfunction, and even quadriplegia. Also have difficulty swallowing, dysphonia and other symptoms. These symptoms have a certain relationship with the degree of onset, the length of onset, and the physical condition of the individual. Most of them are light and not taken seriously by people. Most of them can recover on their own, and they are light and heavy. Only when the symptoms continue to increase and cannot be reversed, it will only attract attention when it affects work and life. If the disease is cured for a long time, it will cause psychological damage, resulting in insomnia, irritability, anger, anxiety, depression and other symptoms.

The clinical symptoms of cervical spondylosis are more complicated. Mainly neck pain, upper limb weakness, finger numbness, lower limb weakness, difficulty walking, dizziness, nausea, vomiting, and even blurred vision, tachycardia and difficulty swallowing. The clinical symptoms of cervical spondylosis are related to the location of lesions, the degree of tissue involvement and individual differences.

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