Cervicogenic headache (GB) is an urgent problem of mankind, and not only medical. According to doctors, up to 40% of patients in clinics are persons with GB. The duration of the attack and its strength determine the quality of a person’s life, due to which the pathological condition turns into an important social complexity. It is necessary to remember the consequences of an attack - a decrease in the working capacity of mental, physical, feelings, stresses that affect relations with family and friends. Studies have shown that only dementia and impaired blood flow in the brain (rather than GB) require more substantial material investments for treatment among all neurological pathologies.
general information
GB is primary, secondary. They speak of primary when the symptomatology of pain is the center of the clinical picture. Cervicogenic headache - a condition in which the head hurts as a result of impaired functionality of the cervical spine. The frequency of occurrence of such a pathological condition practically coincides with the number of migraine cases and is estimated at 5% on average.
Cervicogenic headache (encoded as G44.8 in the ICD) is formed if the receptors responsible for the pain are irritated. These are located in areas of the hard shell of the brain, in arteries at the base of this organ and outside the skull, as well as in the tissues that are lined with an external cranial covering. All types of GB are caused by irritation of these receptors, regardless of what became the root cause of the phenomenon. There are three main nerves associated with the pathogenesis of pain: vagus, trigeminal, glossopharyngeal. In addition, GB is due to the activity of the three upper roots of the spinal cord.
Status Update
The study of cervicogenic headaches is the responsibility of a specialized commission for which prominent doctors from around the world are involved. The commission developed criteria that must be taken into account when studying the patient's condition and making a diagnosis. You can talk about cervicogenic GB if the patient can detect during the laboratory tests, X-ray studies or clinical examinations localized in the cervical spine or soft cervical tissues, while the doctor suggests that the problem is significant enough to provoke a pain syndrome.
A cervicogenic headache recorded in ICD-10 under the code G44.8 is possible if the patient’s examination showed clinical manifestations of pain accompanied by anatomical cervical formations. When diagnosing GB, the doctor can block the cervical structures in order to check the effect on the strength of sensations. With their disappearance, we can talk about the cervicogenic nature of the phenomenon. If it is possible to choose the right course that is suitable for a particular case, after passing it, the symptoms disappear for a quarter of a year or longer.
Diagnostic nuances
The initial diagnosis is made during a clinical study of the patient's condition. For the determination of cervicogenic headache (code in the international classifier G44.8), the patient’s complaints and his medical history are of particular importance. The doctor should clarify how long the syndrome worries, whether it arises from time to time or whether the sensations are constant, stable. It is necessary to clarify how often the pain comes, and how long each attack lasts. As part of the initial examination, painful areas are localized and the spread of the syndrome is assessed. It is necessary to fix in the map whether half of the head is involved in the process or whether the whole is completely. The nature of the sensations should be clarified with the patient - is there a pulsation, a feeling of pressure, is the pain bursting, dull or acute. The patient should describe the intensity of the syndrome to the doctor — mild soreness, moderate or high.
In the diagnosis of cervicogenic pain, it should be clarified at what time of day the sensations come more often when they become stronger. The card includes whether the attack is accompanied by nausea, increased sensitivity to light, vomiting, fear of sounds, nasal congestion. GB may be accompanied by tears, narrowing of the eye or redness of the eyeballs, as well as other additional manifestations of the pathological condition. For an accurate diagnosis, it is revealed under the influence of which factors the pain becomes stronger, which provokes another attack, which helps to alleviate the condition. During the initial diagnosis, the doctor must specify what medicines the patient uses, how pronounced the effect of their intake.
Attention to detail
Assuming as part of the diagnosis of cervicogenic headaches, it should be clarified with the patient whether phenomena are observed before attacks that make it possible to suspect their approach. Perhaps, in particular, visual impairment, weakening of the muscle tone of the limbs, anxious and irritated, depressed state.
The patient should be interviewed for the similarity of seizures, the presence of differences between them. Assuming cervicogenic GB, it must be remembered that the syndrome can be explained by other causes, severe pathological conditions, which can be suspected only by small manifestations.
What happens?
As can be seen from the reviews, cervicogenic headache is very different. For some, one half of the head hurts, for others - the whole is completely. Someone notes additional symptoms characteristic of migraine, as well as pain, which is associated with autonomic problems. The main reason to suspect the cervicogenic nature of the phenomenon is the appearance of an attack due to neck movement (or stopping in this way). In many patients who come to the clinic because of this pathological condition, the attack is inhibited or stopped by touching in the area of the large occipital nerve, the area where the second root or cervical muscles (trigger zones) come out.
If the patient has a cervicogenic headache, as a rule, the state is not characterized by a change in the region of sensation localization - one side (or always both) is stable. The pain develops in seizures, the duration of which varies from hours to days. During the attack period, the intensity of sensations can vary. The pathological condition in the predominant percentage of cases gradually turns into a chronic one. Another attack often occurs if a person maintains a forced posture for a long time - for example, sleeping. Many note the simultaneous appearance of pain in the shoulder, arm on the same side with which the head hurts.
Relief of an attack
One of the doctor’s tasks is to explain to the patient that cervicogenic GB is not an extremely serious pathological condition, and during the period of an attack, you do not need to completely abandon motor activity or resort to any special devices. Physical activity within reason is not accompanied by risks and dangers, so you should adhere to your usual daily routine if possible, and return to work immediately, as soon as the attack goes down.
For cervicogenic headache, drugs are indicated to relieve soreness - usually non-hormonal anti-inflammatory. Additionally, the doctor prescribes substances that relax muscle fibers and stop cramps. For a day, Balkosan can be prescribed in an amount of up to 30 mg, Flupirtin - up to 600 mg, Tizanilin - up to 12 mg.
Relief Options
A good result in the treatment of cervicogenic headache is the consistent use of ketorolac, nimesulide. As a rule, among the abundance of pharmaceutical products with these components, the drugs Ketorol and Nise are chosen. Dosage and duration of use of ketorolac vary, based on the strength of the attack. The drug is used in injections for intramuscular injections for up to five consecutive days in an amount of 90 mg per day. Ketorol tablets for oral administration can be prescribed in a dose of up to 40 mg per day in the same five-day course, after which the patient is transferred to the Nise reception. The duration of use of this tool varies from a week to two, and the daily dose is 200 mg.
Ketorolac is currently considered one of the most powerful painkillers that do not affect opioid receptors. As part of the treatment of cervicogenic headache, Ketorol gives a good and quick result. Nise is used to maintain the effect. This drug belongs to the class of selectively inhibitory second type of COX substances. Its use helps to minimize the risk of gastrointestinal ulcer formation due to the use of a non-hormonal anti-inflammatory composition.
Chronicle: the nuances of therapy
If a patient has a chronic cervicogenic headache, the treatment program will include the use of antidepressants. Most often, drugs from the tricyclic class are prescribed, and they stop on drugs containing amitriptyline. This substance is prescribed for a day at a dose of 25-75 mg. An alternative is SSRIs. Popular options that have shown good results are medicines containing duloxetine, venlafaxine. They are not inherent in the negative effects exhibited by amitriptyline.
The treatment program for cervicogenic headache almost always includes special treatment procedures. The patient is sent to a course of medical massage. During the manipulation, the doctor acts on the cervical-collar region, part of the head. This massage allows you to relax supporting the spinal column muscles. To improve the condition, a blockade can be prescribed with the use of local anesthetics, usually lidocaine or novocaine in the form of a 5% solution. For blockade can resort to hormonal anti-inflammatory. Most often prescribed "Diprospan", "Hydrocortisone." Well established "Dexmethasone." It is recommended to block the cervical, pericranial muscles through the trigger sites.
Grave condition
If the patient went to the clinic with symptoms of cervicogenic headache, it is necessary to revise the initial diagnosis, suggesting that the cause may lie in a more severe pathological condition, if the pain comes suddenly, reaches a peak intensity in a matter of minutes. Manifestations suggesting a life-threatening disease include the first-appearing pain, significantly different in character from the one that bothered the person before. This can be evidenced by a constantly growing pain in the neck, face, head.
The diagnosis should be reviewed if presumably cervicogenic headache is accompanied by a febrile state or other phenomena covering the body systemically, as well as if neuralgic deficits of certain areas are first formed. A severe pathology may be indicated by the result of Valsava's study, accompanied by an increase in sensation strength.
Procedures and Therapy
Treatment of cervicogenic headache in a hospital often involves referring the patient to physiotherapy using the shock-wave method. Sometimes this approach is quite effective in itself, it allows you to abandon the drug course. The method helps to achieve muscle relaxation, normalizes blood flow in the capillaries of the affected area, weakens pain.
As can be seen from medical practice, with the cervicogenic nature of BG, manual treatment gives excellent results. It is necessary to resort strictly to soft techniques for influencing areas of pain localization. A combination of manual impact and traction of the cervical zone brings a particularly good result. The pain regresses, the symptoms accompanying the syndrome gradually disappear, the head stops spinning, and hypersensitivity to light and sounds disappears.
In a protracted, severe case, treatment of cervicogenic headache in a hospital involves the use of special simulators designed for people with such problems. These are specialized integrated installations for working with the cervical spine. Exercise machines are used to clarify the condition and exercise of muscle tissue. The strength of deep muscle fibers, the mobility of individual vertebral blocks is revealed, and the treatment process has biological feedback. The course of procedures is developed individually. Clinics that offer this approach to treatment guarantee a positive outcome, elimination of muscle imbalance and increased muscle strength. The biomechanics of human mobility is normalized.
Thorough approach
In rare cases, cervicogenic headache therapy involves the operation of the patient. Surgical manipulations consist in the neurolysis of a nerve, which provides sensitivity to the occipital region. The doctor decompresses the roots of the spinal column, works with the sensory ganglion. The success rate of the event is estimated at approximately 90%.
There is evidence of a positive effect of radiofrequency treatment (denervation). The procedure involves working with the synuvertebral nerve, spine roots and joints.
As a rule, cervicogenic headache requires referral of the patient to a psychiatrist, psychotherapist to change cognitive and behavioral patterns. Most people form incorrect ideas about the pathological condition - in many ways they impede the success of the treatment course and reinforce pain. The task of the therapist is to help the patient get rid of dependence on pain medication, increase activity in everyday life.
Relevance of the problem
As can be seen from medical statistics, the relationship between the violation of the functionality of the cervical spine and GB is often overestimated not only by patients, but also by specialists in the field of medicine. Currently, the diagnosis of “cerebral arachnoiditis” has been practically abandoned, “cervical osteochondrosis” is in doubt, many suggest abandoning the diagnosis of vertebral artery syndrome. Instead of all these conditions, cervicogenic GB should be entered into the patient’s map, as many doctors call for.
The symptoms of cervicogenic headache listed above are based on diagnostic criteria introduced by the international commission and entered into the appropriate classifier. In medical practice, the diagnosis is made not only in cases that fall under these conditions, but also to other patients whose pathological manifestations have a number of differences from those listed. On average, cervicogenic GB is diagnosed 6.5 times more often than necessary.
Often mistakenly, such a diagnosis is made to people suffering from migraine, myofascial syndrome, neuralgia. Cervicogenic GB is relatively rare, and the refinement of this condition, its treatment is associated with some difficulties.
International criteria
A specialized commission proposed the introduction of additional criteria that must be considered when diagnosing a condition if cervicogenic GB is assumed. Those were divided into main and auxiliary. The first category includes signs indicating that the pathological condition affects the structure of the neck. This may result from an increase in soreness against the background of motor activity, during a test with inclinations, turns, and palpation. The main criteria include the limited mobility of the cervical vertebral region and soreness in this area, arm or shoulder. It is necessary to distinguish the nature of sensations from those caused by radiculitis. To diagnose cervicogenic GB, it is necessary that the patient has at least one of these main signs.
Among the auxiliary phenomena that help to make an accurate diagnosis is the stability of the localization area - sensations never shift to the opposite side. To confirm the condition, a blockade should be made using an analgesic medication - this procedure should give a guaranteed effect.
In order to be able to establish cervicogenic GB, it is necessary to clarify the nature of the sensations. Soreness should not be pulled or fired, the start of sensations is usually observed in the neck, and the intensity varies from medium to very strong. , , . , , . , .
Case features
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Curious to know
Studies were conducted, an analysis of a sample of patients suffering from GB of a different nature, with suspicion falling on the cervicogenic type of phenomenon. If we take into account five of the six criteria listed above, the diagnosis in question could be made approximately 4.6% of patients, while the requirement of compliance with all six criteria reduced the number of patients to 1%.
Doctors have determined that the incidence of cervicogenic GB in a population depends on the nature of the disorder. On average, the cervicogenic aspect is observed in every fifth person suffering from chronic or prone to relapse GB. This allows us to speak with confidence about the dysfunction of the cervical region of the spinal column as an element leading to chronic primary headache.
Home gymnastics
Exercise will help with cervicogenic headache. You can practice the gymnastics complex recommended by the doctor, you can supplement it with general strengthening and kneading exercises. What kind of gymnastics program a specialist will prescribe depends on the characteristics of the case, but the general exercises that are useful to any person suffering from hypertension will be considered further.
It is necessary to take a comfortable sitting position, put the right palm on the head on the left, tilt the head to the right side. A pose is supported by several exhalations, then they change sides. When doing the exercise, you need to slightly press the palm on the surface of the head. The human task is to stretch the vertebrae of the cervical spine.
In the intervals between exercise therapy procedures, gymnastics with cervicogenic headache can be practiced as follows: sit on the floor, slightly lowering the legs from each other and putting them in parallel. Hands behind the back are fastened with a lock, bent until the head touches the surface of the floor. In the lowest position, they measure up to five, inhaling and exhaling deeply. Hands are pulled back, stretching the chest, flexing shoulders, neck at the back.
Exercises: Simple and Affordable
To alleviate cervicogenic GB, you can lie on your back, bend your knees, hug them with your hands outside at the level of your feet or hips. Pose support for several minutes, swaying in different directions, back and forth. The idea of such gymnastics is to stretch the femoral muscles and improve blood supply to the lower back.
Another exercise begins with spreading a blanket against the wall. To do this, you need to take a couple of pillows, sit as close to the wall as possible, then lie on your back on a blanket and raise your legs along the wall, spread them apart to the extent that there are stretch marks (pillows are placed under the buttocks). At the same time, they spread out their arms to the sides, close their eyes and try to breathe measuredly and calmly. The pose is maintained while there is a feeling of comfort.
Sirdalud against cervicogenic GB
The use of muscle relaxants in the fight against the pathological condition under consideration has proven itself well, and the effect fully justifies the possible disadvantages of such treatment. Most often resort to the drug "Sirdalud", which affects the segmental, suprasegmental increased activity of spinal nocireceptors, gammamotoneurons. It is noted that the tool, relaxing muscle fibers, is generally characterized by increased capabilities, and there is an assumption that all the advantages of such therapy have not yet been investigated. Under the influence of the drug, the activity of intrafusal structures changes, the afferentation of the blue spot is corrected, and a suprasegmental slowing effect on gammamotoneurons is observed.
In hypertension, persistent increased muscle tone is caused by a violation of segmental neural slowdown, in the process of mediation of which interneurons are involved. The drug slows down the release of glutamate, reduces the excessive activity of neurons, but does not correct the function of the alpha type of such structures, that is, it does not inhibit the ability of the muscle to contract, its strength. The use of Sirdalud medication allows you to take control of muscle tone, fiber spasticity.
In some cases, the effect affects intrafusal structures via GABA receptors. This is observed when taking drugs containing baclofen, as well as barbiturates. For segmental control of muscle tone, drugs containing tolperisone are used to correct tissue spasticity, since this compound has an inherent reticulospinal effect.