Women's College Hospital Centre for Headache, Division of Neurology, University of Toronto, Toronto, Canada.
The Hospital for Sick Children, Division of Neurology, Department of Pediatrics, Toronto, M5G 1X8, Canada.
Curr Neurol Neurosci Rep. 2019 Mar 19;19(5):20. doi: 10.1007/s11910-019-0937-8.
Occipital neuralgia (ON) and cervicogenic headache (CGH) are secondary headache disorders with occipital pain as a key feature. Due to significant phenotypic overlap, differentiating ON and CGH from primary headache disorders such as migraine or tension-type headache, or other secondary headache disorders, can be clinically challenging. This article reviews the anatomy, clinical features, unique diagnostic considerations, and management approaches relating to ON and CGH.
Conservative therapeutic approaches are considered first-line. Anesthetic nerve blocks may have a dual role in both supporting diagnosis and providing pain relief. Newer minimally invasive procedures, such as pulsed radiofrequency (PRF) and occipital nerve stimulation (ONS), represent an exciting therapeutic avenue for severe/refractory cases. Surgical interventions should be reserved for select patient populations who have failed all other conservative and minimally invasive options, to be weighed against potential risk. ON and CGH represent an ongoing diagnostic challenge. Further studies are required to consolidate efficacy regarding the comprehensive management of ON and CGH.
枕神经痛（ON）和颈源性头痛（CGH）是继发性头痛疾病，以枕部疼痛为主要特征。由于表型显著重叠，区分 ON 和 CGH 与偏头痛或紧张型头痛等原发性头痛疾病，或其他继发性头痛疾病，可能具有临床挑战性。本文综述了与 ON 和 CGH 相关的解剖结构、临床特征、独特的诊断注意事项和治疗方法。
保守治疗方法被认为是一线治疗方法。麻醉神经阻滞可能在支持诊断和缓解疼痛方面具有双重作用。新型微创介入治疗方法，如脉冲射频（PRF）和枕神经刺激（ONS），为严重/难治性病例提供了令人兴奋的治疗途径。手术干预应保留给所有其他保守和微创治疗方法均失败的特定患者群体，需权衡潜在风险。ON 和 CGH 仍然是一个诊断挑战。需要进一步的研究来巩固 ON 和 CGH 综合管理的疗效。
