Gasik Robert
Instytut Reumatologii w Warszawie, Klinika Spondylo-Neurochirurgii i Neurologii.
Pol Merkur Lekarski. 2008 Jun;24(144):549-51.
In 2004 cervicogenic headache was introduced into ICD-10 classification. The reasons of cervicogenic headache are changes within bones, soft tissue and nervous structures of cervical spine section. The pain may spread to the neck, occipital area of skull, area of jaw and eyeballs, and arms. There are many theories trying to explain spreading of the pain outside the area innervated by C1, C2 and C3 cervical roots. Their common denominator is communication between fibres running in those roots and neurons of trigeminal nerve. Many authors describe a possibility of such connection through the jelly-like nucleus of the trigeminal nerve located in the back funiculi of spinal cord. In this mechanism, the pain conducted via occipital nerves may affect activity of neurons of the trigeminal nerve and influence areas innervated by the trigeminal nerve. In general case history and physical examination are sufficient to make a diagnosis. Additional radiological and imaging examinations support this diagnosis. According to some authors, the necessary condition to make a diagnosis of cervicogenic headache is finding the changes of spondylosis nature of the cervical spine section in additional examinations. In doubtful cases, diagnostic blockade of greater occipital nerve, resulting in headache relief, supports finally a diagnosis. Any treatment includes pharmacotherapy, rehabilitation, psychotherapy and surgical methods. The purpose of the study is to view literature on cervicogenic headache which causes many diagnostic problems and hence makes it difficult to choose effective treatment.
2004年,颈源性头痛被纳入国际疾病分类第十版(ICD - 10)。颈源性头痛的病因是颈椎节段的骨骼、软组织及神经结构发生改变。疼痛可扩散至颈部、颅骨枕部、颌部及眼球区域,还有手臂。有许多理论试图解释疼痛为何会扩散至颈1、颈2和颈3神经根所支配区域之外。它们的共同之处在于这些神经根中的纤维与三叉神经神经元之间存在联系。许多作者描述了通过位于脊髓后索的三叉神经胶状核实现这种连接的可能性。在这种机制中,经枕神经传导的疼痛可能会影响三叉神经神经元的活动,并影响三叉神经所支配的区域。一般来说,病史和体格检查足以做出诊断。额外的放射学和影像学检查有助于支持这一诊断。根据一些作者的观点,做出颈源性头痛诊断的必要条件是在额外检查中发现颈椎节段存在颈椎病性质的改变。在可疑病例中,枕大神经诊断性阻滞导致头痛缓解,最终支持诊断。任何治疗方法都包括药物治疗、康复治疗、心理治疗及手术方法。本研究的目的是审视关于颈源性头痛的文献,这种头痛引发了诸多诊断问题,因而难以选择有效的治疗方法。