Department of Neurology, National Hospital Organization Miyagi National Hospital, Yamamoto-cho, Miyagi, Japan.
Department of Neurology, Tohoku Medical and Pharmaceutical University Hospital, Sendai, Miyagi, Japan.
Headache. 2024 Apr;64(4):464-468. doi: 10.1111/head.14698. Epub 2024 Mar 25.
Nerve fibers related to pain and temperature sensation in the trigeminal nerve territory converge with the upper cervical spinal nerves from the level of the lower medulla oblongata to the upper cervical cord. This structure is called the trigemino-cervical complex and may cause referred pain in the territory of the trigeminal or upper cervical spinal nerves.
Here, we report three cases of paroxysmal neuralgia in the occipital region with mild conjunctivitis or a few reddish spots in the ipsilateral trigeminal nerve territory. The patients exhibited gradual progression of these reddish spots evolving into vesicles over the course of several days, despite the absence of a rash in the occipital region. The patients were diagnosed with trigeminal herpes zoster and subsequently received antiherpetic therapy. Remarkably, the neuralgia in the occipital region showed gradual amelioration or complete resolution before the treatment, with no sequelae reported in the occipital region.
The trigemino-cervical complex has the potential to cause neuralgia in the occipital region, as referred pain, caused by trigeminal herpes zoster. These cases suggest that, even if conjunctivitis or reddish spots appear to be trivial in the trigeminal nerve territory, trigeminal herpes zoster should be considered when neuralgia occurs in the ipsilateral occipital region.
三叉神经区域的痛觉和温度觉相关神经纤维与从延髓下部到颈上脊髓的上颈脊神经相汇聚。这种结构被称为三叉-颈复合体，可能导致三叉神经或上颈脊神经区域的牵涉痛。
在这里，我们报告了三例位于枕部的阵发性神经痛病例，这些患者伴有同侧三叉神经区域的轻度结膜炎或少量红斑。尽管患者的枕部没有皮疹，但这些红斑逐渐进展，几天后发展成水疱。患者被诊断为三叉神经带状疱疹，随后接受了抗病毒治疗。值得注意的是，枕部的神经痛在治疗前逐渐缓解或完全缓解，枕部没有留下任何后遗症。
三叉-颈复合体有可能引起枕部神经痛，作为牵涉痛，由三叉神经带状疱疹引起。这些病例表明，即使在三叉神经区域出现轻微的结膜炎或红斑，当同侧枕部出现神经痛时，也应考虑三叉神经带状疱疹。
