11.颈源性头痛和枕神经痛。

IF 2.5 3区 医学 Q2 ANESTHESIOLOGY
Pain Practice Pub Date : 2024-09-01 DOI:10.1111/papr.13405
Nicole Lefel, Hans van Suijlekom, Steven P C Cohen, Jan Willem Kallewaard, Jan Van Zundert
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引用次数: 0

摘要

导言:颈源性头痛(CEH)和枕神经痛(ON)是源于枕部并放射至顶点的头痛。由于枕部结构与上颈部结构之间的密切关系,颈源性头痛和枕神经痛的表现形式有很大的重叠。诊断首先要了解头痛病史,评估是否符合国际头痛协会制定的诊断标准。体格检查主要评估颈部的活动范围以及是否存在压痛区或压痛点:方法:检索了2015年至2022年8月有关CEH和ON诊断和治疗的文献,并进行了检索和总结:保守治疗包括疼痛教育和自我护理、镇痛药物、物理治疗(如减轻继发性肌肉紧张和改善姿势)、使用TENS(经皮神经电刺激)或上述治疗方法的组合。在不同的解剖位置注射局部麻醉剂,同时使用或不使用皮质类固醇,可在短期内缓解疼痛。深部颈丛神经阻滞可使疼痛在 6 个月内得到改善。在 CEH 和 ON 中,枕神经阻滞可提供重要的诊断信息,并改善部分患者的疼痛,而 PRF 可提供更好的长期疼痛控制。颈椎面关节射频消融术可使疼痛改善超过 1 年。在治疗难治性颈椎病时,应考虑使用枕神经刺激疗法(ONS):结论:治疗颈椎病的首选方法是对关节面进行射频治疗,而治疗颈椎病的方法则是对枕神经进行脉冲射频治疗。对于难治性病例,可考虑使用 ONS。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
11. Cervicogenic headache and occipital neuralgia.

Introduction: Cervicogenic headache (CEH) and occipital neuralgia (ON) are headaches originating in the occiput and that radiate to the vertex. Because of the intimate relationship between structures based in the occiput and those in the upper cervical region, there is significant overlap between the presentation of CEH and ON. Diagnosis starts with a headache history to assess for diagnostic criteria formulated by the International Headache Society. Physical examination evaluates range of motion of the neck and the presence of tender areas or pressure points.

Methods: The literature for the diagnosis and treatment of CEH and ON was searched from 2015 through August 2022, retrieved, and summarized.

Results: Conservative treatment includes pain education and self-care, analgesic medication, physical therapy (such as reducing secondary muscle tension and improving posture), the use of TENS (transcutaneous electrical nerve stimulation), or a combination of the aforementioned treatments. Injection at various anatomical locations with local anesthetic with or without corticosteroids can provide pain relief for a short period. Deep cervical plexus block can result in improved pain for less than 6 months. In both CEH and ON, an occipital nerve block can provide important diagnostic information and improve pain in some patients, with PRF providing greater long-term pain control. Radiofrequency ablation of the cervical facet joints can result in improvement for over 1 year. Occipital nerve stimulation (ONS) should be considered for the treatment of refractory ON.

Conclusion: The treatment of CEH preferentially consists of radiofrequency treatment of the facet joints, while for ON, pulsed radiofrequency of the occipital nerves is indicated. For refractory cases, ONS may be considered.

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来源期刊
Pain Practice
Pain Practice ANESTHESIOLOGY-CLINICAL NEUROLOGY
CiteScore
5.60
自引率
3.80%
发文量
92
审稿时长
6-12 weeks
期刊介绍: Pain Practice, the official journal of the World Institute of Pain, publishes international multidisciplinary articles on pain and analgesia that provide its readership with up-to-date research, evaluation methods, and techniques for pain management. Special sections including the Consultant’s Corner, Images in Pain Practice, Case Studies from Mayo, Tutorials, and the Evidence-Based Medicine combine to give pain researchers, pain clinicians and pain fellows in training a systematic approach to continuing education in pain medicine. Prior to publication, all articles and reviews undergo peer review by at least two experts in the field.
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