Mathew Paul G, Sailesh Samuel
Department of Neurology, Mass General Brigham Health, 22 Patriot Place, Foxborough, MA, 02035, USA.
Department of Neurology, Atrius Health, Quincy, MA, USA.
Curr Pain Headache Rep. 2025 Jul 21;29(1):101. doi: 10.1007/s11916-025-01419-7.
Occipital neuralgia, cervicogenic headache, and migraine are disorders that are commonly accompanied by neck pain. Although these disorders may present with similar features, coexist in the same patient, and have variable degrees of involvement of the C2 and C3 nerve roots, it is important to distinguish between these three entities, as the presumed diagnosis can lead to different diagnostic and therapeutic modalities.
Occipital neuralgia in particular is underdiagnosed, occipital nerve blocks are underutilized, and technical aspects that can influence the efficacy of occipital nerve blocks are not taught in most clinical training programs. There are often significant delays in referring refractory cases for interventional and surgical management. In patients presenting with headache and neck pain, making an accurate diagnosis is critical in order to optimize management. Without addressing comorbid diagnoses, patients tend to have suboptimal responses to both acute and preventative headache pharmacological therapies.
枕神经痛、颈源性头痛和偏头痛是常伴有颈部疼痛的疾病。尽管这些疾病可能表现出相似的特征，在同一患者中共存，并且C2和C3神经根受累程度不同，但区分这三种疾病很重要，因为推测的诊断可能导致不同的诊断和治疗方式。
特别是枕神经痛诊断不足，枕神经阻滞未得到充分利用，并且大多数临床培训项目中未传授可影响枕神经阻滞疗效的技术方面。将难治性病例转诊至介入和手术治疗往往会有显著延迟。对于出现头痛和颈部疼痛的患者，准确诊断对于优化治疗至关重要。如果不处理合并诊断，患者对急性和预防性头痛药物治疗的反应往往不理想。
