Yi Xiaobin, Cook Andrew J, Hamill-Ruth Robin J, Rowlingson John C
Division of Pain Medicine, Department of Anesthesiology, University of Virginia Health System, Charlottesville, Virginia, USA.
J Pain. 2005 Oct;6(10):700-3. doi: 10.1016/j.jpain.2005.04.005.
The differential diagnosis of headache is often challenging, with significant clinical and socioeconomic consequences of incomplete or inaccurate diagnosis. Overlapping symptoms contribute to the diagnostic challenge. Four female patients, ages 26 to 69 with standing diagnoses of migraine, were evaluated and treated for complaints of chronic, severe headaches. All had obtained limited relief from migraine therapies. On physical examination, all had occipital nerve tenderness or positive Tinel sign over the occipital nerve. All responded well to occipital nerve blocks with local anesthetic, achieving complete or substantial pain relief lasting up to 2 months. We conclude that accurate diagnosis of occipital neuralgia or cervicogenic headache as contributing factors can lead to substantial headache relief through occipital nerve blocks in patients with coexisting or misdiagnosed migraine.
The pathophysiology of many types of chronic headaches is not well understood. Mixed mechanisms such as neurovascular, neuropathic, myofascial, and cervicogenic may all contribute. Our four patients with chronic headaches responded well to occipital nerve blocks. The neuroanatomical relationship between the trigeminocervical nucleus and occipital nerve may serve as the basis of efficacy for these blocks.
头痛的鉴别诊断往往具有挑战性，诊断不完整或不准确会带来重大的临床和社会经济后果。症状重叠加剧了诊断难题。对4名年龄在26至69岁、已确诊偏头痛的女性患者进行了评估和治疗，她们均主诉患有慢性重度头痛。所有患者从偏头痛治疗中获得的缓解都很有限。体格检查时，所有患者枕神经均有压痛或枕神经Tinel征阳性。所有患者对局部麻醉剂枕神经阻滞反应良好，疼痛完全或大幅缓解，持续长达2个月。我们得出结论，准确诊断枕神经痛或颈源性头痛为致病因素，可使合并偏头痛或误诊偏头痛的患者通过枕神经阻滞大幅缓解头痛。
多种类型慢性头痛的病理生理学尚未完全明了。神经血管、神经病变、肌筋膜和颈源性等多种机制可能都有作用。我们的4例慢性头痛患者对枕神经阻滞反应良好。三叉颈核与枕神经之间的神经解剖关系可能是这些阻滞有效的基础。
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