Giblin Kathryn, Newmark Jordan L, Brenner Gary J, Wainger Brian J
Massachusetts General Hospital, Boston, Massachusetts, USA.
Pain Med. 2014 Mar;15(3):473-8. doi: 10.1111/pme.12334. Epub 2014 Jan 8.
To describe a case of cervicogenic headache with associated autonomic features and pain in a trigeminal distribution, all of which responded to third occipital nerve radiofrequency ablation.
Single case report.
Massachusetts General Hospital Center for Pain Medicine.
A 38-year-old woman with history of migraines and motor vehicle accident.
Right third occipital nerve diagnostic blocks and radiofrequency lesioning.
Pain reduction; physical findings, including periorbital and mandibular facial swelling, tearing, conjunctival injection, and allodynia; and use of opioid and non-opioid pain medicines.
The patient had complete relief of her pain and autonomic symptoms, and was able to stop all pain medications following a dedicated third occipital nerve lesioning.
This case illustrates the diagnostic and therapeutic complexity of cervicogenic headache and the overlap with other headache types, including trigeminal autonomic cephalgias and migraine. It represents a unique proof of principle in that not only trigeminal nerve pain but also presumed neurogenic inflammation can be relieved by blockade of cervical nociceptive inputs. Further investigation into shared mechanisms of headache pathogenesis is warranted.
描述一例伴有自主神经特征及三叉神经分布区疼痛的颈源性头痛病例，所有这些症状均对枕大神经射频消融治疗有反应。
单病例报告。
马萨诸塞州总医院疼痛医学中心。
一名38岁女性，有偏头痛病史及机动车事故史。
右侧枕大神经诊断性阻滞及射频毁损术。
疼痛减轻情况；体格检查结果，包括眶周及下颌面部肿胀、流泪、结膜充血及痛觉过敏；阿片类及非阿片类镇痛药的使用情况。
患者疼痛及自主神经症状完全缓解，在进行专门的枕大神经毁损术后能够停用所有止痛药物。
该病例说明了颈源性头痛的诊断和治疗复杂性以及与其他头痛类型（包括三叉自主神经性头痛和偏头痛）的重叠情况。它代表了一个独特的原理证明，即不仅三叉神经痛，而且推测的神经源性炎症也可通过阻断颈部伤害性传入而得到缓解。有必要对头痛发病机制的共同机制进行进一步研究。
