颅脑术后颈源性头痛的诊断及治疗探讨

Diagnosis and treatment of post-craniotomy cervicogenic headache

目的分析颅脑术后并发颈源性头痛患者的临床特点,以指导颅脑手术后头痛的治疗。方法总结22例颅脑术后颈源性头痛患者的临床特点和诊断、治疗经过。记录头痛的发病时间、疼痛性质、查体体征,比较应用类固醇激素神经阻滞前后疼痛程度数字评分、颈项僵硬和颈部活动度的变化。结果颅脑术后颈源性头痛出现于术后第2～3天,第3～5天逐渐加重;疼痛呈间歇性或持续性(初起多呈单侧),同时伴有同侧颈枕部和(或)肩部疼痛酸困、僵硬等症状,影响睡眠及颈部正常活动。查体可见颈部肌肉紧张,枕大、枕小、耳大神经或颈2横突压痛明显,并向同侧头部放射,引颈试验阳性。头部CT均为术后正常改变。神经阻滞后疼痛程度明显降低,治疗后5d时,数字评分(NRS)由术前的8.27±0.89降至1.03±0.56(P<0.01);颈部僵硬明显缓解,治疗后5d时,颈椎活动度评分(ROM)由术前的2.45±0.71降至1.01±0.22(P<0.01)。结论颈源性头痛是术后重度头痛的原因之一,神经阻滞对于缓解颅脑手术后的颈源性头痛有显著疗效。

Objective To analyze the clinical features of post-craniotomy cervicogenie headache and to explore the treatment of post-craniotomy pain. Methods Clinical information of 22 cases suffered from severe post-eraniotomy cervicogenic headache （all diagnosed by International Headache Society Diagnostic Criteria） were analyzed including onset and characteristic of the headache, physical examination results, severity of headache before and after the nerve blockade therapy obtained using an 11-point numeric rating scales, and changes of cervical flexion-rotation test. Results Post-craniotomy cervicogenic headache always occurred after 2-3 days of operation and aggravated 1-2 days later. The headache could be persistent or intermittent, followed by homolateral occipital and/or shoulder pain, which affected patients＇ sleep quality and cervical flexion. Physical examination revealed cervical muscle tension and tenderness of greater occipital nerve, lesser occipital nerve, great auricular nerve and C2 region, which could irradiate to the homolateral head. Severity of headache and cervical rigidity improved dramatically after nerve blockade therapy. Conclusions Cervicogenie factor plays an important role in post-craniotomy headache, and nerve blockade therapy produces a marked effect in treating post-craniotomy cervieogenic headache.