急性颅脑损伤后颈源性头痛的治疗

The treatment of cervicogenic headache after acute traumatic brain injury

目的探讨急性颅脑损伤后颈源性头痛的发病特点及治疗效果,分析其发病原因及治疗对策。方法选择14例轻度颅脑损伤后出现重度头痛、按照颈源性头痛(CEH)的国际诊断标准确定为CEH的患者进行研究。根据查体体征行枕大、枕小、耳大神经或颈2横突阻滞,应用曲安奈德10mg配成利多卡因浓度为0.4%的消炎镇痛液,每个穿刺点注射3ml。观察治疗前后头痛程度数字评分(NRS)、颈部僵硬感和颈部活动度(ROM)。结果治疗前NRS为(8.21±1.15)分,治疗后15min、第1天、第3天和第5天分别降低至(1.36±0.64)分、(1.71±0.88)分、(1.62±0.72)分和(1.09±0.29)分,与治疗前比较均有显著性差异(P﹤0.01);ROM由治疗前的(2.43±0.73)分,降低至(1.21±0.41)分、(1.14±0.35)分、(1.07±0.26)分和(1.07±0.26)分,与治疗前比较均有显著性差异(P﹤0.01)。结论CEH可能是急性颅脑损伤后头痛的原因之一,行类固醇激素神经阻滞对于缓解颅脑损伤后的CEH症状有显著的疗效。

Objective To explore the clinical characteristics of cervicogenic headache（CEH） after acute traumatic brain injury and investigate the therapeutic strategy. Methods Fourteen CEH patients who were suffered from mild traumatic brain injury and complained of severe headache were treated by occipital neural blockade and C2 neural blockade with a mixture of 0.4% lidocaine and lOmg triamcinolone acetonide. After blockade the pain degree（numeric rating scales, NRS）, the degree of cervical stiff and the range of motion of the neck （ROM） were observed. Results Compared with NRS （8.21±1.15） and ROM scores （2.43±0.73） before treatment, NRS on the first, the third and the fifth day after treatment was 1.71±0.88, 1.62±0.72 and 1.09±0.29 respectively（P 〈 0.01）, ROM was 1.14±0.35, 1.07±0.26 and 1.07±0.26 respecfively（P 〈 0.01）. Conclusions Neural blockade is proved to have a significant effect in the treatment of CEH after acute brain injury.