Cervical headache

Cervical headache

Cervical headache is a headache caused by a non-invasive disorder of any structure of the neck, including bone, muscles, and other soft tissues, and is usually but not always accompanied by neck pain

Cervical headache is a nonhereditary, unilateral, or bilateral headache in which some patients may have a history of

Pain on one side of the head or face: Neck-induced headaches are mostly one-sided or alternating bilateral headaches (headaches can occasionally be bilateral if both structures of the neck are involved at the same time), with persistent pain in one area, such as one, anterior, or posterior side of the head or eye, and rarely a total headache

Neck movement can aggravate headaches: headaches start in the neck pillow, can be spread along the neck pillow to the parietal temporal area, a few occur on the forehead or orbit, with the neck occipital pain being the most intense, neck movement, coughing, strain will aggravate the headache

Restricted neck movement: the neck is stiff and unable to move

The onset or exacerbation of symptoms can range from hours to weeks: headaches are often paroxysmal at first, and later become chronically fluctuating headaches; The pain is stable, no pulsating pain, mostly jumping, stabbing, swelling, burning pain, can also be knife cutting or radioactive, pull-like pain, usually chronic hidden pain or numbing soreness

Headaches when coughing, sneezing, or breathing deeply, and the onset of pain can last for hours or days

During the progression of cervical headache, possible complications include:

●Headache, often accompanied by tinnitus, dizziness, hearing impairment;

●Nausea, vomiting;

●Fear of light, fear of sound;

●A small number of people have eye swelling or inverted eyeballs;

●Unequal pupils;

●Lacrimation, conjunctival congestion

Causes and common diseases of cervical headache

The cause of CEH is not fully understood

(1) inflammatory stimulation in the spinal canal and / or mechanical compression of the C1-C3 nerve roots by the intervertebral disc;

(2) Cervical facet joint disorders, muscle spasms and/or inflammatory stimulation of ligament fascia outside the spinal canal or mechanical entrapment of the C1-C3 nerve root branch (mainly including: the suboccipital nerve derived from the posterior branch of the C1 nerve root, the occipital large nerve derived from the posterior branch of the C2 and C3 nerve roots, the 3rd occipital nerve derived from the posterior branch of the C3 nerve root, the occipital small and large ear nerve derived from the anterior branch of the C2 and C3 nerve roots

Data show that 70% of cervical headaches are caused by C2-3 facet joint lesions

Principles of treatment

Treatment of cervical headaches follows the principle

●Conservative treatment

Conservative management is the treatment of choice for cervical headache and consists mainly of oral medication, physical therapy, and manual therapy

●Minimally invasive nerve block injection therapy

Minimally invasive nerve block injection therapy is suitable for the next step of treatment that does not respond to conservative treatment or has poor effect, including: occipital large/small occipital nerve block injection therapy, posterior cervical nerve branch block injection therapy, paracervical lesion injection therapy, and epidural injection therapy

●Epidural nerve release + continuous epidural injection

Epidural nerve release + continuous epidural injection therapy is the next step in the treatment of

●Neuroradiofrequency thermocoagulation

Neuroradiofrequency thermocoagulation is a destructive technique and may be considered as a treatment option that is ineffective or ineffective in non-neurological injury therapy

●C2-3 dorsal root ganglion pulsed radiofrequency therapy

C2-3 dorsal root ganglion pulsed radiofrequency therapy may also be considered as a next step in treatment that is ineffective or ineffective in non-nerve injury therapy
.
However, the level of evidence for efficacy in the treatment of cervical headache is 0 (only in case reports, and the evidence for efficacy and safety is insufficient
).

●Surgical treatment of open cervical spine

Open surgical treatment of the cervical spine can be used as a next step
in the treatment of minimally invasive neurointerventional surgery that is ineffective or ineffective.
The results showed that both high (C2-3/C3-4) and low (C4-5/C5-6/C6-7) cervical disc removal fusion were effective in relieving cervical headaches, while the mechanism of low disc removal fusion in the treatment of cervical headaches may be related
to nerve root decompression and indirect changes in the position structure of the high cervical vertebral body.
Similarly, the level of evidence for efficacy in the treatment of cervical headache is insufficient and needs to be confirmed
by further randomized controlled studies.