Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Health Sciences, Academic Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L), University of Luebeck, Luebeck, Germany.
Cephalalgia. 2021 Jan;41(1):78-89. doi: 10.1177/0333102420954518. Epub 2020 Aug 31.
The importance of neck pain and the trigeminocervical complex in migraine is of high pathophysiological interest since a block to the greater occipital nerve is more effective for some primary headaches than others. This observational study hypothesised that the response to manual palpation of the upper cervical spine predicts the efficacy of the greater occipital nerve-block.
We divided patients, scheduled by a neurologist to receive a greater occipital nerve-block to reduce their migraine symptoms, into three groups: Patients with no pain response to manual palpation of the neck, patients with local pain, and those with referred pain to the head. Primary outcome was the percentage change in headache frequency. Additionally, items from the quantitative sensory testing protocol were included.
Eighty-seven chronic migraine patients were recruited consecutively from a specialised outpatient clinic and 71 were included for analyses and stratified into the three groups: No pain (n = 11), local pain (n = 28), and referred pain to the head (n = 32). Overall, patients experienced a reduction of 1.9 headache days per month (SD 3.4, < 0,0001). The groups differed significantly in the percentage change of headache frequency ( = 0.041) with the "no pain" group showing the largest reduction. The pressure-pain-threshold over C2 and headache on the day of the intervention influenced the outcome significantly (R 0,27, = 0,00078). No serious adverse events occurred. Sixty-five percent of the patients had headaches during the examination. The groups did not differ regarding the distribution of patients with neck-pain in absence of migraine at baseline ( = 0.618).
Patients that were less sensitive to palpation in the cervical region and headache-free on the day of the intervention improved more after the greater occipital nerve-block.Registration: Registered at the German Clinical Trials Register (DRKS00015995).
颈痛和三叉颈椎复合体在偏头痛中的重要性具有较高的病理生理学意义，因为相较于其他原发性头痛，枕大神经阻滞对一些头痛更为有效。本观察性研究假设，颈椎上部触诊的反应可预测枕大神经阻滞的疗效。
我们将因偏头痛症状而由神经科医生安排接受枕大神经阻滞的患者分为三组：颈部触诊无疼痛反应的患者、局部疼痛的患者和头部牵涉痛的患者。主要结局是头痛频率的变化百分比。此外，还纳入了定量感觉测试方案的项目。
我们连续从一个专门的门诊诊所招募了 87 例慢性偏头痛患者，其中 71 例被纳入分析并分为三组：无疼痛（n=11）、局部疼痛（n=28）和头部牵涉痛（n=32）。总体而言，患者每月头痛天数减少了 1.9 天（SD=3.4， < 0.0001）。头痛频率变化百分比在三组之间存在显著差异（ = 0.041），“无疼痛”组的降幅最大。C2 上的压力-疼痛阈值和干预当天的头痛对结果有显著影响（R 0,27， = 0,00078）。未发生严重不良事件。65%的患者在检查过程中有头痛。在基线时无偏头痛的颈部疼痛患者的分布在三组之间无差异（ = 0.618）。
颈椎区域触诊不敏感且干预当天无头痛的患者在接受枕大神经阻滞治疗后改善更为明显。
在德国临床试验注册处（DRKS00015995）注册。
