We describe an innovative technique of ultrasound-guided greater occipital nerve (GON) hydrodissection for treatment of cervicogenic headache and occipital neuralgia. A 35-year-old female presented to the pain clinic ...We describe an innovative technique of ultrasound-guided greater occipital nerve (GON) hydrodissection for treatment of cervicogenic headache and occipital neuralgia. A 35-year-old female presented to the pain clinic with severe chronic cervicogenic headache impacting her sleep, work and activities of daily living. Conservative management had failed to adequately resolve her pain. Ultrasound-guided suboccipital hydrodissection of the greater occipital nerve was performed with the patient in the prone position. After skin sterilization, the linear ultrasound transducer was oriented in a transverse orientation at the level of the C2-C3 vertebrae. The needle was advanced from medial to lateral “in-plane” under direct ultrasound visualization, until the needle was positioned at the C2 lamina. After confirming the needle tip position, 10 ml of hydrodissection fluid was injected with good visualization of distribution of the solution. The patient described immediate and significant improvement in her symptoms. She reported a sustained decrease in pain scores when followed up in the pain clinic at six and twelve weeks respectively. To the best of our knowledge this is the first application of ultrasound-guided hydrodissection of the GON for cervicogenic headache. It offers a novel, safe and effective technique to aid in the diagnosis and treatment of a common pain condition.展开更多
Cervicogenic headache(CEH)has been recognized as a unique category of headache that can be difficult to diagnose and treat.In China,CEH patients are managed by many different specialties,and the treatment plans remain...Cervicogenic headache(CEH)has been recognized as a unique category of headache that can be difficult to diagnose and treat.In China,CEH patients are managed by many different specialties,and the treatment plans remain controversial.Therefore,there is a great need for comprehensive evidence-based Chinese experts’recommendations for the management of CEH.The Chinese Association for the Study of Pain asked an expert panel to develop recommendations for a series of questions that are essential for daily clinical management of patients with CEH.A group of multidisciplinary Chinese Association for the Study of Pain experts identified the clinically relevant topics in CEH.A systematic review of the literature was performed,and evidence supporting the benefits and harms for the management of CEH was summarized.Twenty-four recommendations were finally developed through expert consensus voting for evidence quality and recommendation strength.We hope this guideline provides direction for clinicians and patients making treatment decisions for the management of CEH.展开更多
Objective: To address the degree and duration of pain relief from recurrent cervicogenic headaches and/or occipital neuralgia following retreatment with radiofrequency ablation of the C2 dorsal root ganglion and/or th...Objective: To address the degree and duration of pain relief from recurrent cervicogenic headaches and/or occipital neuralgia following retreatment with radiofrequency ablation of the C2 dorsal root ganglion and/or third occipital nerves;to review outcomes including duration and degree of pain relief;to evaluate procedure’s complication rate and patient’s willingness to repeat the procedure;to compare effectiveness of the most recent RF ablation to patient’s first RF ablation. Methods: This is a single-center retrospective observational study of 23 patients with recurrent cervicogenic headaches and/or occipital neuralgia treated with repeated RF ablation of the C2 dorsal root ganglion and/or third occipital nerves. All patients receiving treatment from January 2010 to July 2014 are included in this single site retrospective study. This is an IRB approved medical chart review study. Results: 22 of 23 patients underwent follow-up. An average of 86.5% of participants reported pain relief on average of 25.4 weeks at time of follow-up. 41% reported side effects including suboccipital hyperesthesia and/or ear discomfort, 95% reported willingness to repeat the procedure again if severe symptoms recurred, 59% of patients reported the most recent RF ablation had the same results as the first, 32% reported the most recent RF was the most effective, and 9% reported that the first RF was the most effective. Conclusion: Repeated RF ablation is a feasible option for recurrent cervicogenic headaches and/or occipital neuralgia. Effectiveness of repeat intervention is the same or better than the first ablation. Though there was a higher likelihood of side effects including suboccipital neuralgia and/or ear discomfort on repeat treatment, the side effects were generally well tolerated.展开更多
As early as 1983,Sjaastad proposed the concept of cervicogenic headache(CH)in the World Headache Conference,that is,the pain from upper cervical joints and muscles can be referred to the head.CH is a group of syndrome...As early as 1983,Sjaastad proposed the concept of cervicogenic headache(CH)in the World Headache Conference,that is,the pain from upper cervical joints and muscles can be referred to the head.CH is a group of syndromes mainly caused by dysfunction of the upper cervical spine and its component muscles,ligaments,bony,vertebral arteries and/or soft tissue elements,usually not accompanied by neck pain.Therefore,the treatment strategy of CH focuses on pain relief and repair cervical lesions.Patients with painful disorders of upper cervical zygapophysial joints showed significant headache relief after directly treated at disordered cervical joints[1].展开更多
Since it was put forward in 1995,musculo-dural bridge has been widely concerned.With the deepening of research,the structure,shape and physiological functions of musculo-dural bridge are gradually known.Previous studi...Since it was put forward in 1995,musculo-dural bridge has been widely concerned.With the deepening of research,the structure,shape and physiological functions of musculo-dural bridge are gradually known.Previous studies have found that the musculo-dural bridge between muscle and dura mater can not only transfer proprioception,prevent the rupture of dura mater and ensure the normal flow of cerebrospinal fluid,but also be related to chronic cervicogenic headache.Therefore,this article mainly discusses the composition of musculo-dural bridge complex and its relationship with chronic cervicogenic headache,so as to provide a new diagnosis and treatment idea for the occurrence,development and treatment of related diseases in clinic.展开更多
目的:探讨经筋刺法结合肌肉能量技术(Muscle Energy Technique,MET)治疗颈源性头痛(Cervicogenic Headache,CEH)的临床效果。方法:将福建省南平市第二医院就诊的107例颈源性头痛患者随机分为对照组(54例)和治疗组(53例)。对照组采用传...目的:探讨经筋刺法结合肌肉能量技术(Muscle Energy Technique,MET)治疗颈源性头痛(Cervicogenic Headache,CEH)的临床效果。方法:将福建省南平市第二医院就诊的107例颈源性头痛患者随机分为对照组(54例)和治疗组(53例)。对照组采用传统经穴针刺+推拿,治疗组采用经筋针刺+MET,记录治疗前后患者疼痛相关指标、颈椎活动度、脑多普勒超声检查等变化。结果:与治疗前比,治疗后2组疼痛相关指标、椎动脉血流速度(除对照组Vp)均有明显下降(P<0.001),AROM有明显上升(P<0.001)。与对照组比,治疗后治疗组疼痛相关指标、椎动脉血流速度均有明显下降(P<0.001,P<0.05),AROM有明显上升(P<0.001)。结论:经筋针刺联合肌肉能量技术治疗颈源性头痛能有效降低疼痛相关指标,缩短头痛持续时间,降低头痛发生频率,改善颈椎活动度,改善椎动脉收缩期血流异常。展开更多
文摘We describe an innovative technique of ultrasound-guided greater occipital nerve (GON) hydrodissection for treatment of cervicogenic headache and occipital neuralgia. A 35-year-old female presented to the pain clinic with severe chronic cervicogenic headache impacting her sleep, work and activities of daily living. Conservative management had failed to adequately resolve her pain. Ultrasound-guided suboccipital hydrodissection of the greater occipital nerve was performed with the patient in the prone position. After skin sterilization, the linear ultrasound transducer was oriented in a transverse orientation at the level of the C2-C3 vertebrae. The needle was advanced from medial to lateral “in-plane” under direct ultrasound visualization, until the needle was positioned at the C2 lamina. After confirming the needle tip position, 10 ml of hydrodissection fluid was injected with good visualization of distribution of the solution. The patient described immediate and significant improvement in her symptoms. She reported a sustained decrease in pain scores when followed up in the pain clinic at six and twelve weeks respectively. To the best of our knowledge this is the first application of ultrasound-guided hydrodissection of the GON for cervicogenic headache. It offers a novel, safe and effective technique to aid in the diagnosis and treatment of a common pain condition.
文摘Cervicogenic headache(CEH)has been recognized as a unique category of headache that can be difficult to diagnose and treat.In China,CEH patients are managed by many different specialties,and the treatment plans remain controversial.Therefore,there is a great need for comprehensive evidence-based Chinese experts’recommendations for the management of CEH.The Chinese Association for the Study of Pain asked an expert panel to develop recommendations for a series of questions that are essential for daily clinical management of patients with CEH.A group of multidisciplinary Chinese Association for the Study of Pain experts identified the clinically relevant topics in CEH.A systematic review of the literature was performed,and evidence supporting the benefits and harms for the management of CEH was summarized.Twenty-four recommendations were finally developed through expert consensus voting for evidence quality and recommendation strength.We hope this guideline provides direction for clinicians and patients making treatment decisions for the management of CEH.
文摘Objective: To address the degree and duration of pain relief from recurrent cervicogenic headaches and/or occipital neuralgia following retreatment with radiofrequency ablation of the C2 dorsal root ganglion and/or third occipital nerves;to review outcomes including duration and degree of pain relief;to evaluate procedure’s complication rate and patient’s willingness to repeat the procedure;to compare effectiveness of the most recent RF ablation to patient’s first RF ablation. Methods: This is a single-center retrospective observational study of 23 patients with recurrent cervicogenic headaches and/or occipital neuralgia treated with repeated RF ablation of the C2 dorsal root ganglion and/or third occipital nerves. All patients receiving treatment from January 2010 to July 2014 are included in this single site retrospective study. This is an IRB approved medical chart review study. Results: 22 of 23 patients underwent follow-up. An average of 86.5% of participants reported pain relief on average of 25.4 weeks at time of follow-up. 41% reported side effects including suboccipital hyperesthesia and/or ear discomfort, 95% reported willingness to repeat the procedure again if severe symptoms recurred, 59% of patients reported the most recent RF ablation had the same results as the first, 32% reported the most recent RF was the most effective, and 9% reported that the first RF was the most effective. Conclusion: Repeated RF ablation is a feasible option for recurrent cervicogenic headaches and/or occipital neuralgia. Effectiveness of repeat intervention is the same or better than the first ablation. Though there was a higher likelihood of side effects including suboccipital neuralgia and/or ear discomfort on repeat treatment, the side effects were generally well tolerated.
文摘As early as 1983,Sjaastad proposed the concept of cervicogenic headache(CH)in the World Headache Conference,that is,the pain from upper cervical joints and muscles can be referred to the head.CH is a group of syndromes mainly caused by dysfunction of the upper cervical spine and its component muscles,ligaments,bony,vertebral arteries and/or soft tissue elements,usually not accompanied by neck pain.Therefore,the treatment strategy of CH focuses on pain relief and repair cervical lesions.Patients with painful disorders of upper cervical zygapophysial joints showed significant headache relief after directly treated at disordered cervical joints[1].
基金This research was supported by National Natural Science Foundation of China(No.81873388)Shaanxi University of Traditional Chinese Medicine Meridian-Zang Fu Related Research Innovation Team Project(2019-YL09).
文摘Since it was put forward in 1995,musculo-dural bridge has been widely concerned.With the deepening of research,the structure,shape and physiological functions of musculo-dural bridge are gradually known.Previous studies have found that the musculo-dural bridge between muscle and dura mater can not only transfer proprioception,prevent the rupture of dura mater and ensure the normal flow of cerebrospinal fluid,but also be related to chronic cervicogenic headache.Therefore,this article mainly discusses the composition of musculo-dural bridge complex and its relationship with chronic cervicogenic headache,so as to provide a new diagnosis and treatment idea for the occurrence,development and treatment of related diseases in clinic.
文摘目的:探讨经筋刺法结合肌肉能量技术(Muscle Energy Technique,MET)治疗颈源性头痛(Cervicogenic Headache,CEH)的临床效果。方法:将福建省南平市第二医院就诊的107例颈源性头痛患者随机分为对照组(54例)和治疗组(53例)。对照组采用传统经穴针刺+推拿,治疗组采用经筋针刺+MET,记录治疗前后患者疼痛相关指标、颈椎活动度、脑多普勒超声检查等变化。结果:与治疗前比,治疗后2组疼痛相关指标、椎动脉血流速度(除对照组Vp)均有明显下降(P<0.001),AROM有明显上升(P<0.001)。与对照组比,治疗后治疗组疼痛相关指标、椎动脉血流速度均有明显下降(P<0.001,P<0.05),AROM有明显上升(P<0.001)。结论:经筋针刺联合肌肉能量技术治疗颈源性头痛能有效降低疼痛相关指标,缩短头痛持续时间,降低头痛发生频率,改善颈椎活动度,改善椎动脉收缩期血流异常。
