Cervicalgia, cervicocranialgia, and cervicogenic headache
https://doi.org/10.14412/2074-2711-2014-2-90-96
Abstract
Pain syndromes in the neck and head regions are one of the most difficult conditions to be interpreted in clinical practice. Craniocervical anatomical and physiological features are a basis for development of mixed pain syndromes showing as a polymorphic clinical picture in the presence of not only painful, but also tonic muscle, autonomic, postural, vestibular, and other disorders. The current concept of cervicocranialgia is based on the views and convergence between cranial (trigeminal) and upper cervical afferents, as supported by clinical and experimental data. These mechanisms are responsible for referred pain phenomena that are so characteristic of myofascial pain syndromes in the neck, head, and face. Myofascial pain may both be independent and occur in other types of primary headaches, specifically in migraine and tension headache. In these cases, the clinical symptomatology takes the features that are highly characteristic of myofascial pain: referred pain with a typical pattern of its spread, as well as trigger points and pain associated with postural loads and other physical factors. These peculiarities should be kept in mind when diagnosing pain syndromes in the craniocervical region. Current approaches to managing patients with cervicocranialgias encompass relief of pain and tonic muscle disorders and compensation for postural disturbances. For this, it is customary to use pharmacotherapy with antidepressants, nonsteroidal anti-inflammatory drugs, and myorelaxants. Effective analgesia in these patients still remains an unsolved problem. Analysis of clinical trials can identify the most effective analgesic and safe agents for pharmacotherapy. The phenomena of myofascial pain determine the expediency of using myorelaxants that exert an intrinsic analgesic effect and reduce tonic muscle phenomena.
About the Author
G.R. Tabeeva
I.M. Sechenov First
Moscow State Medical University, Moscow
Russian Federation
Russian Federation
Division of Neurology and Clinical Neurophysiology, Department of Nervous System Diseases and Neurosurgery
References
1. Nilsson N. The prevalence of cervicogenic headache in a random population sample of 20-59 year olds.Spine (Phila Pa 1976). 1995;20(17):1884–8.DOI: http://dx.doi.org/10.1097/00007632-199509000-00008.
2. Bogduk N. The Neck and Headaches. Neurol Clin.2014 May;32(2):471–87. DOI: http://dx.doi.org/10.1016/j.ncl.2013.11.005.
3. Fejer R, Kyvik K, Hartvigsen J. The prevalence ofneck pain in the world population: a systematic reviewof literature. Eur Spine J. 2006;15(6):834–48.DOI: http://dx.doi.org/10.1007/s00586-004-0864-4.Epub 2005 Jul 6.
4. Core D, Sepic S, Gardner G, Murray MP. Neckpain: a long-term follow-up of 205 patients. Spine(Phila Pa 1976). 1987;12(1):1–5.DOI: http://dx.doi.org/10.1097/00007632-198701000-00001.
5. Australian Acute Musculoskeletal Pain GuidelinesGroup. Evidence Based Management of AcuteMusculoskeletal Pain. Brisbane: Australian AcademicPress; 2004.
6. Gross A, Hoving J, Haines T, et al. A Cochranetrview of manipulation and mobilization for mechanicalneck disorders. Spine (Phila Pa 1976).2004;29(14):1541–8. DOI: http://dx.doi.org/10.1097/01.BRS.0000131218.35875.ED.
7. Trevor-Jones R. Osteoarthritis of the paravertebraljoints of the second and third cervical vertebrae as acause of occipital headaches. S Afr Med J.1964;38:392–4.
8. Pentecost SP, Adriani J. The use of cervical plexusblock in the diagnosis and management of atypicalcephalalgia of cervical origin. Anesthesiology.1955;16(5):726–32. DOI: http://dx.doi.org/10.1097/00000542-195509000-00011.
9. Bogduk N, Marsland A. On the concept of the thirdoccipital nerve. J Neurol Neurosurg Psychiatry.1986;49(7):775–80. DOI: http://dx.doi.org/10.1136/jnnp.49.7.775.
10. Lord SM, Barnsley L, Wallis BJ, Bogduk N. Thirdoccipital headache: prevalence study. J NeurolNeurosurg Psychatry. 1994;57(10):1187–90.DOI: http://dx.doi.org/10.1136/jnnp.57.10.1187.
11. Govind J, King W, Giles P, et al. Headache and thecervical zygapophyseal joints (cervicogenic/cervicalheadache). J Bone Joint Surg. 2005;87-B SupplIII:399–440.
12. Giamberardino MA, Affaitati G, Fabrizio A,Costantini R. Myofascial pain syndromes and theirevaluation. Best Pract Res Clin Rheumatol. 2011Apr;25(2):185–98. DOI:http://dx.doi.org/10.1016/j.berh.2011.01.002.
13. Govind J. Headache and the upper cervicalzygapophyseal joints. In: Headache, orofacial pain andbruxism. Selvaratham P, Niele K, Zulnaga M, editors.Churchill Livingstone Elsevier. 2009. P. 43–53.DOI: http://dx.doi.org/10.1016/B978-0-443-10310-0.00005-8.
14. Gadsby PJ, Hoskin KL. The distribution oftrigeminovascular afferents in the nonhuman primatebrain Macaca nemestrina: a c-fos immunocytochemicalstudy. J Anat. 1997;190(Pt 3):367–75.DOI: http://dx.doi.org/10.1046/j.1469-7580.1997.19030367.x.
15. Dwyer A, Aprill C, Bogduk N. Cervicalzygapophyseal joint pain patters I. A study in normalvolonteers. Spine. 1990;15(6):453–7.DOI: http://dx.doi.org/10.1097/00007632-199006000-00004.
16. Sjaastad O, Saunte C, Hovdal H, et al.«Cervicogenic» headache. An hypothesis. Cephalalgia.1983;3(4):249–56.DOI: http://dx.doi.org/10.1046/j.1468-2982.1983.0304249.x.
17. Leone M, D'Amigo D, Grazzi L, et al.Cervicogenic headache: a critical review of currentdiagnostic criteria. Pain. 1998;78(1):1–5. DOI:http://dx.doi.org/10.1016/S0304-3959(98)00116-X.
18. Bartsch T, Goadsby P. Increased responses in intrigeminocervical nociceptive neurons to cervical inputafter stimulation of the dura mater. Brain. 2003;126(Pt 8):1801–13. DOI: http://dx.doi.org/10.1093/brain/awg190. Epub 2003 Jun 23.
19. Cote P, Cassidy J, Caroll L. Is a lifetime history ofneck injury in a traffic collision associated with prevalentneck pain, headache and depressive symptomatology?Accid Anal Prev. 2000;32(2):151–9. DOI:http://dx.doi.org/10.1016/S0001-4575(99)00117-7.
20. Radanov BP, Di-Stefano G, Augustiny KF.Simptomatic approach to posttraumativ headache andits possible implications for treatment. Eur Spine J.2001;10(5):403–7. DOI:http://dx.doi.org/10.1007/s005860000227.
21. Barnsley L, Lord S, Bogduk N, Bogduk N. Falsepositiverates of cervical zygapopheseal joint blocks.Clin J Pain. 1993;9(2):124–30.DOI: http://dx.doi.org/10.1097/00002508-199306000-00007.
22. Боренштейн ДГ, Визель С, Боден С.Боли в шейном отделе позвоночника.Диагностика и комплексное лечение. Москва:Медицина; 2005. 792 с. [Borenshtein DG, Vizel' S,Boden S. Boli v sheinom otdele pozvonochnika.Diagnostika i kompleksnoe lechenie [Pains in cervicaldepartment of a backbone. Diagnostics and complextreatment]. Moscow: Meditsina; 2005. 792 p.]
23. Hagen K, Einarsen C, Zwart J, et al. The cooccuranceof headache and musculoskeletal symptomsamong 51050 adults in Norway. Eur J Neurol.2002;9(5):527–33. DOI:http://dx.doi.org/10.1046/j.1468-1331.2002.00451.x.
24. Табеева ГР. Цервикогенные головные боли:клинические и терапевтические аспекты. Русскиймедицинский журнал. 2013;20(29):1478–83.[Tabeeva GR. Cervicogenic headaches: clinical andtherapeutic aspects. Russkii meditsinskii zhurnal.2013;20(29):1478–83. (In Russ.)]
25. Hubka MJ. Cervicogenic disfunction in musclecontraction headache and migraine: a dicriptive study.J Manipul Physiol Ther. 1993;16(6):428–31.
26. Li YH, Li J, Huang Y, et asl. Gastroprotective effect and mechanism of amtolmetin guacyl in mice.World J Gastroenterol. 2004 Dec 15;10(24):3616–20.
27. Tavella A, Ursini G. A clinical study on the anti-inflammatory activity and gastrointestinal tolerability of amtolmetin guacyl, a new NSAID, compared with diclofenac in aged patients with osteoarticular diseases.Clin Ter. 1997 Nov;148(11):543–8.
28. Veenema KR, Leahey N, Schneider S. Ketorolacversus meperidine: ED treatment of severe musculoskeletallow back pain. Am J Emerg Med. 2000Jul;18(4):404–7.DOI: http://dx.doi.org/10.1053/ajem.2000.7314.
29. Giamberaldino MA, Tafuri E, Savini A, et al.Contribution of myofascial trigger points to migrainesymptoms. J Pain. 2007;8(11):869–78.DOI: http://dx.doi.org/10.1016/j.jpain.2007.06.002.Epub 2007 Aug 9.
30. Gerwin R. Myofascial pain syndrome. In: Musclepain. Diagnosis and treatment. Mense S, Gerwin R,editors. Springer; 2010. P. 17–83. DOI:http://dx.doi.org/10.1007/978-3-642-05468-6_2.
31. Delwaide PJ, Pennisi G. Tizanidine and electrophysiologicanalysis of spinal control mechanisms in humans with spasticity. Neurology. 1994;44(11 Suppl 9):21–7.
32. Mojica JAP, Mancao BD, Perez MLP, et al.A dose-finding therapeutic trial on tizanidine in Filipinos with acute muscle spasm. Philipp J InternMed. 1994;32:141–5.
33. Hutchinson DR, Daniels F. A multinational studyin general practice to evaluate the effectiveness andtolerability of tizanidine in the treatment of painful muscle spasms. Br J Clin Res. 1990;1:39–48.
34. Manfredini D, Romagnoli M, Bosco M. Efficacyof tizanidine hydrochloride in the treatment of myofascial face pain. Minerva Med. 2004Apr;95(2):165–71.
35. Malanga GA, Gwynn MW, Smith R, Miller D.Tizanidine is effective in the treatment of myofascial pain syndrome. Pain Physician. 2002;5(4):422–32.
Review
For citations:
Tabeeva G. Cervicalgia, cervicocranialgia, and cervicogenic headache. Neurology, Neuropsychiatry, Psychosomatics. 2014;6(2):90-96. (In Russ.) https://doi.org/10.14412/2074-2711-2014-2-90-96
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