Iskra D A, Koshkarev M A, Litvinenko I V, Dyskin D E, Kovalenko A P
Kirov Medical-Military Aacademy, St.-Petersburg, Russia.
Zh Nevrol Psikhiatr Im S S Korsakova. 2019;119(5):80-85. doi: 10.17116/jnevro201911905180.
To study the informative nature of manual therapy for differential diagnosis of migraine and cervicogenic headache (CH).
The authors analyze two clinical cases of patients with a previously established diagnosis of migraine, with the duration of the disease of over ten years and neuroimaging signs of degenerative-dystrophic changes in the upper cervical spine. In both cases, there was no hereditary history and low efficacy of the previous drug therapy was noted. The informative value of the tests performed by methods of manual medicine followed by manipulation procedures of neck structures for the differential diagnosis of migraine and CH was assessed.
Despite the absence of complaints, both patients demonstrated the limitation of the volume of neck movements during the tests performed by methods of manual medicine. After a course of manipulation procedures, headaches in both patients were completely stopped for a period of six to ten months. The analysis of literature suggests that manipulative effects on neck structures in cases of migraine can reduce the intensity and the duration of pain, and the frequency of attacks by no more than 20%. The therapeutic effectiveness of manual therapy for CH is much higher; this method provides an opportunity to reduce the severity of these pain characteristics by 30-80%. These results are the basis for changing the previously established diagnosis to CH.
The complex of diagnostic and therapeutic techniques of manual therapy is an important tool for the differential diagnosis of migraine and CH.
研究手法治疗对偏头痛和颈源性头痛（CH）鉴别诊断的信息价值。
作者分析了两例先前已确诊为偏头痛的患者的临床病例，病程超过十年，且上颈椎有退行性营养不良改变的神经影像学征象。两例患者均无家族病史，且先前药物治疗效果不佳。评估了采用手法医学方法进行检查并随后对颈部结构进行手法操作对偏头痛和CH鉴别诊断的信息价值。
尽管患者无相关主诉，但在采用手法医学方法进行检查时，两名患者均表现出颈部活动度受限。经过一个疗程的手法操作后，两名患者的头痛均完全停止了六至十个月。文献分析表明，对偏头痛患者的颈部结构进行手法治疗可使疼痛强度、持续时间及发作频率降低不超过20%。手法治疗对CH的疗效要高得多；该方法可使这些疼痛特征的严重程度降低30% - 80%。这些结果是将先前确诊的疾病改为CH的依据。
手法治疗的诊断和治疗技术组合是偏头痛和CH鉴别诊断的重要工具。
