Mathew Paul G, Najib Umer, Khaled Shaoleen, Krel Regina
Department of Neurology (PGM), Brigham and Women's Hospital, Boston; Department of Neurology (PGM), Harvard Vanguard Medical Associates, Braintree; Division of Neurology (PGM), Cambridge Health Alliance; Harvard Medical School (PGM), Boston, MA; Department of Neurology (UN), West Virginia University, School of Medicine, Morgantown, WV; St. George's University (SK), School of Medicine, Grenada, WI; Hackensack Meridian School of Medicine at Seton Hall University (RK), Nutley; and Neuroscience Institute at Hackensack University Medical Center (RK), Hackensack, NJ.
Neurol Clin Pract. 2021 Feb;11(1):6-12. doi: 10.1212/CPJ.0000000000000789.
Occipital neuralgia (ON) is a paroxysmal disorder involving lancinating pain that originates in the neck or skull base with superior radiation toward the apex. ON more commonly occurs in patients with other coexisting headache disorders. There are limited data regarding the prevalence of ON. This study aims to demonstrate the prevalence of ON in a community hospital-based headache clinic.
This IRB-approved retrospective study was conducted at the Cambridge Health Alliance Headache Clinic. Medical records of patients presenting with headache as a chief complaint were reviewed from January 2010 to September 2015.
Of 800 study patients, 81% were females (n = 648). A total of 195 patients were diagnosed with ON, and 146 patients had a positive occipital Tinel sign on examination. Isolated ON was present in 15.38% (n = 30) of patients. Multiple regression analysis demonstrated that the odds of ON were higher in patients with chronic migraine vs episodic migraine (adjusted odds ratio = 2.190 [95% confidence interval: 1.364-3.515]), even when adjusted for significant covariates.
ON occurred in nearly 25% of patients presenting with a chief complaint of headache to a community hospital-based headache clinic. Among patients with ON, 15% presented with ON as the chief complaint without another coexisting headache disorder. As such, up to 85% of ON cases occurred in patients having an additional headache type. Approximately 75% of patients with ON had a positive occipital Tinel sign on examination. Elevated body mass index, higher age at presentation, and chronic migraine increased the odds of having ON. Undiagnosed or inadequate treatment of ON can increase the frequency and intensity of other comorbid headache disorders.
枕神经痛（ON）是一种阵发性疾病，表现为刺痛，疼痛起源于颈部或颅底，并向上放射至头顶。枕神经痛更常见于同时患有其他头痛疾病的患者。关于枕神经痛的患病率数据有限。本研究旨在证明社区医院头痛门诊中枕神经痛的患病率。
这项经机构审查委员会批准的回顾性研究在剑桥健康联盟头痛门诊进行。回顾了2010年1月至2015年9月以头痛为主诉就诊患者的病历。
在800名研究患者中，81%为女性（n = 648）。共有195名患者被诊断为枕神经痛，146名患者检查时枕神经Tinel征呈阳性。孤立性枕神经痛见于15.38%（n = 30）的患者。多因素回归分析表明，慢性偏头痛患者发生枕神经痛的几率高于发作性偏头痛患者（调整后的优势比 = 2.190 [95%置信区间：1.364 - 3.515]），即使在对显著协变量进行调整后也是如此。
在社区医院头痛门诊以头痛为主诉就诊的患者中，近25%发生枕神经痛。在枕神经痛患者中，15%以枕神经痛为主诉，无其他并存的头痛疾病。因此，高达85%的枕神经痛病例发生在患有其他头痛类型的患者中。约75%的枕神经痛患者检查时枕神经Tinel征呈阳性。体重指数升高、就诊时年龄较大和慢性偏头痛会增加发生枕神经痛的几率。枕神经痛未被诊断或治疗不当会增加其他合并头痛疾病的发作频率和强度。
