CERVICOGENIC HEADACHE: ETIOPATHOGENESIS, CHARACTERISTICS, DIAGNOSIS, DIFFERENTIAL DIAGNOSIS AND THERAPY
Autori:
Vjekoslav Grgić
Sažetak
Sažetak. Termin »cervikogena glavobolja« (CG) označava kronični hemikranijski bolni sindrom uzrokovan poremećajima gornje vratne kralježnice. Prema kliničkim istraživanjima, u 15–20% bolesnika s kroničnom unilateralnom glavoboljom posrijedi je glavobolja cervikalnog podrijetla. Izvorišta prenesene boli koja se očituje CG-om jesu poremećaji anatomskih struktura koje oživčavaju prva tri cervikalna spinalna živca i/ili izravna iritacija/oštećenje tih živaca (spinalni živci C1-C3, intervertebralni/i.v. zglobovi C0-C3, i.v. disk C2-C3, mišići, ligamenti, koštane strukture, dura mater, vertebralne arterije). Neuroanatomska i neurofiziološka istraživanja dokazala su konvergenciju bolnih podražaja iz inervacijskog područja spinalnih živaca C1-C3 i inervacijskog područja trigeminalnog živca koja se odigrava u trigeminocervikalnoj jezgri smještenoj u gornjim segmentima vratnog dijela kralježnične moždine. Zbog konvergencije bolnih podražaja u trigeminocervikalnoj jezgri, bol iz inervacijskog područja spinalnih živaca C1-C3 prenosi se u inervacijsko područje trigeminalnog živca (glava, lice), a bol iz inervacijskog područja trigeminalnog živca prenosi se u inervacijsko područje spinalnih živaca C1-C3 (cervikookcipitalno područje). Dijagnoza CG-a može se postaviti na temelju anamneze, kliničke slike, kliničkog pregleda i radioloških pretraga te potvrditi anestetičkom blokadom aficirane strukture. U diferencijalnoj dijagnozi treba isključiti druge oblike glavobolje, prije svega migrenu i tenzijsku glavobolju zbog velike sličnosti s CG-om. U tretmanu CG-a primjenjuju se: medikamentna terapija, akupunktura, neuralna terapija, lokalna injekcija botulinskog otrova, cervikalna epiduralna injekcija kortikosteroida, fizikalna terapija, masaža, manualna terapija, kineziterapija, trakcija i kirurški tretman. Čini se da se najbolji rezultati postižu kombinacijom manualne terapije, fizikalne terapije i kineziterapije. Iako je CG uvrštena u Međunarodnu klasifikaciju glavobolja, taj hemikranijski bolni sindrom još uvijek je nepoznat širemu krugu liječnika. Stoga je svrha ovoga članka opisati etiopatogenezu, karakteristike, dijagnozu, diferencijalnu dijagnozu i terapiju CG-a.
Summary
Summary. The term »cervicogenic headache« (CH) implies a chronic hemicranial pain syndrome caused by upper cervical spine disorders. According to the clinical researches, in 15–20% of the patients with chronic unilateral headache, it is the case of the headache of cervical origin. The sources of the referred pain manifested as CH are the disorders of anatomical structures innervated by the first three cervical spinal nerves and/or direct irritation/lesion of these nerves (spinal nerves C1-C3, intervertebral/i.v. joints C0-C3, i.v. disc C2-C3, muscles, ligaments, bony structures, dura mater, vertebral arteries). Neuroanatomical and neurophysiological researches have proven the convergence of nociceptive afferents from the receptive field of the spinal nerves C1-C3, and nociceptive afferents from the receptive field of the trigeminal nerve which occurs in the trigeminocervical nucleus located in the upper segments of the cervical part of the spinal cord. Because of the convergence of the nociceptive afferents in the trigeminocervical nucleus, the pain from the receptive field of the spinal nerves C1-C3is referred into the receptive field of the trigeminal nerve (head, face), and the pain from the receptive field of the trigeminal nerve is referred into the receptive field of the spinal nerves C1-C3 (cervico-occipital area). Diagnosis of CH can be made on the basis of history, clinical picture, clinical examination and radiological examinations, and confirmed by anesthetic blockade of the affected structure. It is necessary to rule out the other forms of headache in differential diagnosis, first of all migraine and tension headache because of their great similarity with CH. The following is used in the treatment of the CH: medical therapy, acupuncture, neural therapy, local botulinum toxin injection, cervical epidural corticosteroid injection, physical therapy, massage, kinezitherapy, traction and surgical treatment. It seems that the best results are achieved by a combination of manual therapy, physical therapy and kinezitherapy. Although the CH has been included into International headache classification, this hemicranial pain syndrome has still been unknown to a wider circle of medical practicioners. That is why the purpose of this article is to describe etiopathogenesis, characteristics, diagnosis, differential diagnosis and therapy of CH.
