Diener H C, Kaminski M, Stappert G, Stolke D, Schoch B
Department of Neurology, University Duisberg-Essen, Essen, Germany.
Cephalalgia. 2007 Sep;27(9):1050-4. doi: 10.1111/j.1468-2982.2007.01385.x. Epub 2007 Aug 3.
In 1983 Sjaastad published for the first time diagnostic criteria for cervicogenic headache. Until now there have been no prospective studies investigating whether cervical disc prolapse can cause cervicogenic headache. Between July 2002 and July 2003 50 patients with cervical disc prolapse proven by computed tomography, myelography or magnetic resonance imaging were recruited and prospectively followed for 3 months. Patients were asked at different time points about headache and neck pain by questionnaires and structured interviews. These data were collected prior to and 7 and 90 days after surgery for the disc prolapse. Fifty patients with lumbar disc prolapse, matched for age and sex, undergoing surgery were recruited as controls. Headache and neck pain was diagnosed according to International Headache Society (IHS) criteria. Twelve of 50 patients with cervical disc prolapse reported new headache and neck pain. Seven patients (58%) fulfilled the 2004 IHS criteria for cervicogenic headache. Two of 50 patients with lumbar disc prolapse had new headaches. Their headaches did not fulfil the criteria for cervicogenic headache. One week after surgery, 8/12 patients with cervical disc prolapse and headache reported to be pain free. One patient was improved and three were unchanged. Three months after cervical prolapse surgery, seven patients were pain free, three improved and two unchanged. This prospective study shows an association of low cervical prolapse with cervicogenic headache: headache and neck pain improves or disappears in 80% of patients after surgery for the cervical disc prolapse. These results indicate that pain afferents from the lower cervical roots can converge on the cervical trigeminal nucleus and the nucleus caudalis.
1983年，斯贾斯塔德首次发表了颈源性头痛的诊断标准。到目前为止，尚无前瞻性研究调查颈椎间盘突出是否会导致颈源性头痛。在2002年7月至2003年7月期间，招募了50例经计算机断层扫描、脊髓造影或磁共振成像证实为颈椎间盘突出的患者，并对其进行了为期3个月的前瞻性随访。通过问卷调查和结构化访谈，在不同时间点询问患者有关头痛和颈部疼痛的情况。这些数据在椎间盘突出手术前以及手术后7天和90天收集。招募了50例年龄和性别匹配且正在接受手术的腰椎间盘突出患者作为对照。根据国际头痛协会（IHS）标准诊断头痛和颈部疼痛。50例颈椎间盘突出患者中有12例报告出现新的头痛和颈部疼痛。7例患者（58%）符合2004年IHS颈源性头痛标准。50例腰椎间盘突出患者中有2例出现新的头痛。他们的头痛不符合颈源性头痛的标准。颈椎间盘突出手术1周后，8/12例伴有头痛的颈椎间盘突出患者报告疼痛消失。1例患者有所改善，3例患者无变化。颈椎间盘突出手术后3个月，7例患者疼痛消失，3例改善，2例无变化。这项前瞻性研究表明下颈椎间盘突出与颈源性头痛有关：颈椎间盘突出手术后80%的患者头痛和颈部疼痛得到改善或消失。这些结果表明，来自下颈神经根的痛觉传入纤维可汇聚于颈三叉神经核和尾状核。
