Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea.
Korean J Anesthesiol. 2011 Feb;60(2):134-7. doi: 10.4097/kjae.2011.60.2.134. Epub 2011 Feb 25.
The differential diagnosis of headache is often difficult because the symptom of headache is overlapping. Superficial cervical plexus block is useful in diagnosis and treatment of headache. Headache arising from the neck and radiating to the frontotemporal regions and possibly to the supraorbital region has been defined as cervicogenic headache. A positive response to anesthetic blocks is one of the diagnostic criteria of cervicogenic headache. We experienced a case of headache arising from direct lymph node metastasis of hepatocellular carcinoma adjacent to the superficial cervical plexus during treatment of cervicogenic headache under ultrasonographic guidance. Especially in patients with medical history of cancer, practitioners should consider the possibility of metastasis to cervical lymph nodes and using ultrasonography to evaluate the cervical area prior to the practice.
头痛的鉴别诊断往往较为困难，因为头痛的症状有重叠。浅表性颈丛阻滞在头痛的诊断和治疗中很有用。由颈部引起并放射到额颞部，可能放射到眶上区域的头痛被定义为颈源性头痛。对麻醉阻滞的阳性反应是颈源性头痛的诊断标准之一。我们在超声引导下治疗颈源性头痛时，遇到了一例源于紧邻浅表性颈丛的肝细胞癌直接淋巴结转移的头痛病例。特别是对于有癌症病史的患者，在进行操作前，临床医生应该考虑到转移到颈部淋巴结的可能性，并使用超声检查评估颈部区域。
