整脊结合热敏灸治疗颈源性头痛的疗效观察

目的：观察整脊结合热敏灸治疗颈源性头痛的疗效。方法：颈源性头痛患者80例,随机分为2组各40例,观察组采用整脊结合热敏灸治疗,对照组给予塞来昔布胶囊加盐酸乙哌立松片口服治疗。治疗前后进行视觉模拟量表（VAS）评分及疼痛发作次数比较。结果：2组患者治疗1个月后,VAS评分、头痛发作频率均较治疗前明显下降（P〈0．05）,且观察组更低于对照组（P〈0．05）。结论：整脊结合热敏灸治疗颈源性头痛临床疗效优于非甾体抗炎药加肌松药,操作安全,患者易接受,值得进一步临床推广。     

神经阻滞联合小针刀治疗颈源性头痛疗效观察

目的:观察神经阻滞联合小针刀治疗颈源性头痛的效果。方法:将诊断明确的颈源性头痛患者60例随机分为A、B两组,每组30例。A组为治疗组,先行患侧枕大神经、枕小神经、后入路法颈2椎旁神经阻滞,再于患侧枕部和上颈部最多见最敏感的3个压痛点行小针刀治疗,每周1次,共治疗3次。B组为对照组,只行患侧枕大神经、枕小神经、后入路法颈2椎旁神经阻滞治疗。观察每次治疗后、1个月疼痛指标和3个月、6个月后总体疗效。结果:两组治疗颈源性头痛均有明显疗效,但是比较两组治疗效果及远期疗效,A组明显优于B组。结论:神经阻滞联合小针刀治疗颈源性头痛疗效满意,远期疗效优于单纯神经阻滞治疗。     

神经阻滞联合手法治疗颈源性疼痛

目的:观察神经阻滞联合手法治疗颈源性头痛的疗效。方法:颈源性头痛患者30例,其中颞部疼痛患者行耳颞神经阻滞,顶枕部疼痛患者行颈椎旁神经阻滞,均配合手法治疗。结果:治疗2周后,30例患者VAS评分较治疗前明显降低(P0.05),总有效率93.3%;头痛发作次数及持续时间较治疗前明显减少(P0.05)。结论:针对颈源性头痛的不同部位采用神经阻滞并联合手法治疗可有效缓解患者的临床症状,减轻疼痛。     

阻滞联合手法复位治疗颈源性头痛的疗效分析

目的:探讨高位颈椎旁阻滞联合手法复位对颈源性头痛的治疗效果。方法:40例颈源性头痛患者随机分为两组(A,n=20例;B,n=20例),A组接受颈2椎旁阻滞治疗,B组接受手法复位联合颈2椎旁阻滞治疗。比较治疗前后及不同治疗方法治疗后不同时间段,患者的轻、中度头痛天数、剧烈头痛的发作次数及服药剂量。结果:A组接受治疗后1—2个月、3—4个月,患者的每月轻、中度头痛天数、剧烈头痛发作次数及口服非甾体类抗炎药物(NSAID)的剂量分别为:2.5±1.1d、1.0±0.30次、200±50mg/d和7.6±3.5d、1.6±0.4次、860±80mg/d均较治疗前2个月明显减少,差异有极显著意义(P<0.01);B组治疗后1—2个月、3—4个月的数据分别为:2.3±1.0d、1.2±0.45次、300±75mg/d和3.7±2.3d、1.0±0.33次、350±100mg/d,较治疗前2个月明显减少,差异有极显著意义(P<0.01);B组治疗后3—4个月,患者每月头痛天数、剧烈头痛发作次数及口服NSAID的剂量均较A组:7.6±3.5d、1.6±0.4次和860±80mg/d明显减少,差异有显著意义(P<0.05)。结论:高位颈椎旁阻滞联合手法复位治疗颈源性头痛疗效优于单纯高位颈椎旁阻滞,但其远期疗效尚待探讨。     

悬吊运动训练对颈源性头痛的疗效

目的观察悬吊运动训练治疗颈源性头痛的临床疗效。方法颈源性头痛患者60 例,按就诊顺序分为两组。Ⅰ组(n=30)行C2椎旁阻滞,每周1 次;Ⅱ组(n=30)在颈椎旁阻滞基础上配合悬吊运动训练,悬吊运动训练每周3 次。均治疗4 周。观察治疗前与治疗后1 个月、3 个月、6 个月的疼痛视觉模拟评分(VAS)、每月疼痛发作次数及临床疗效。结果治疗后VAS评分,Ⅰ组治疗后1 个月、3 个月,Ⅱ组治疗后1 个月、3 个月、6 个月均较治疗前显著改善(P<0.001);治疗后3 个月、6 个月,Ⅱ组较Ⅰ组改善更显著(P<0.001)。治疗后疼痛发作次数,Ⅰ组治疗后1 个月、3 个月,Ⅱ组治疗后1 个月、3 个月、6 个月均较治疗前减少(P<0.05);治疗后3 个月、6 个月,Ⅱ组较Ⅰ组减少更明显(P<0.05)。治疗后Ⅰ组优良率33.3%,Ⅱ组73.3% (P<0.01)。结论配合悬吊运动训练治疗颈源性头痛优于单一采用颈椎旁阻滞,远期效果更佳。     

手法加电针治疗颈源性头痛的疗效观察

目的 观察手法加电针治疗颈源性头痛疗效。方法 共选取50例 颈源性头痛患者,随机将其分为治疗组和对照组。治疗组在手法基础上采用电针治疗,对照组给予单纯电针治疗。于治疗前、后采用VAS评分对2组患者进行疗效评定。结果 2组患者分别经二个疗程治疗后,发现其VAS评分结果均较治疗前好转,并且均以治疗组的改善幅度较显著,与对照组差异具有统计学意义（P〈0.05）,同时治疗组临床疗效亦显著优于对照组。结论 手法加电针治疗颈源性头痛疗效显著,是临床上比较确切的治疗方法。     

颈椎调整手法配合颈部核心肌群功能锻炼治疗颈源性头痛疗效评价

目的:探究颈椎调整手法配合颈部核心肌群功能锻炼治疗颈源性头痛的疗效。方法:选取符合标准的颈源性头痛患者66例作为本次研究的对象,按随机数表法分为观察组和对照组,对照组32例予以颈椎调整手法治疗,观察组34例予以颈椎调整手法配合颈部核心肌群功能锻炼治疗,治疗6个月后,对比分析2组患者的治疗效果。结果:观察组患者的治疗总有效率(97.05%)明显高于对照组(84.38%),且治疗后的VAS评分明显低于对照组,P0.05。6个月后随访,颈部核心肌群功能锻炼组复发率低。结论:在颈源性头痛的治疗中,将颈椎调整手法配合颈部核心肌群功能锻炼治疗效果确切,达到协同效果,值得推广应用。     

臭氧联合颈椎旁神经阻滞治疗颈源性头痛的临床疗效观察

目的评价臭氧联合颈椎旁神经阻滞治疗颈源性头痛的疗效。方法对178例颈源性头痛患者随机分为对照组(单纯颈椎旁神经阻滞,n=88)和治疗组(臭氧联合颈椎旁神经阻滞治疗,n=90),根据治疗前后的疼痛评分及头痛发作次数的改变,来判定治疗效果。结果在治疗7天后,疼痛评分、头痛发作次数治疗组比对照组均有明显的降低,两组之间疗效差异具有显著性;在随访3个月、6个月后两组间差异不明显。结论臭氧联合颈椎旁神经阻滞能够有效迅速地缓解颈源性头痛。     

超声引导下枕神经阻滞治疗颈源性头痛的临床疗效

目的探讨超声引导下枕神经阻滞在颈源性头痛治疗中的临床疗效。方法将48例颈源性头痛患者随机分成对照组和超声组,每组24例。对照组采用传统盲探操作行患侧枕神经阻滞,超声组采用超声引导下行患侧枕神经阻滞：两组均每周治疗1次,持续2周。比较两组患者穿刺成功率、穿刺次数、穿刺时间、治疗1周和1个月后的视觉模拟（VAS）评分及总有效率的差异。结果与对照组比较,超声组入路的实际穿刺深度和穿刺时间缩短,感觉阻滞增高,穿刺成功率增高,患者满意率增高,差异均有统计学意义（P〈0．05）。两组治疗后1周和1个月的VAS评分均较治疗前下降,治疗后1个月VAS评分较治疗后1周亦下降,但超声组较对照组下降更明显,差异均有统计学意义（P〈0．05）。两组患者均未发生严重并发症。结论超声引导下枕神经阻滞治疗颈源性头痛的方法明显优于传统盲探的治疗方法。     

高位颈椎旁臭氧注射联合手法复位治疗颈源性头痛

目的 探讨高位颈椎旁臭氧注射联合手法复位治疗颈源性头痛的治疗效果.方法 80例颈源性头痛患者随机分为两组(A组42例;B组38例),A组接受颈2椎旁臭氧注射联合手法复位治疗,B组接受颈2椎旁臭氧注射治疗.分别于治疗后1周、1个月和3个月进行疗效评价.结果 治疗后1周、1个月和3个月的VAS评分分别为:A组2.1±1.0、2.1±1.0和2.8±1.5;B组2.2±1.1、3.1±1.8和3.7±2.1.优良率分别为:A组:100％、88.1％、83.3％；B组:94.7％、71.1％、60.5％,组间比较差异有显著性(P＜0.05)；治疗后1个月和3个月的平均VAS评分A组明显低于B组,差异有显著性(P＜0.05)；各组无明显并发症发生.结论 高位颈椎旁臭氧注射联合手法复位治疗颈源性头痛疗效优于单纯高位颈椎旁臭氧注射,但其远期疗效有待于进一步探讨.     

Spinal manipulation and headaches of cervical origin

The role of the cervical spine in headache remains controversial. Often confused as tension or common migraine headache, headaches arising from the neck pose a diagnostic and therapeutic challenge. Practitioners of spinal manipulation have reported very satisfactory results, although the only published randomized controlled trial did not demonstrate that manipulation was significantly helpful. This article reviews the published clinical studies of manipulation in the treatment of tension and migraine headaches. The topic of cervical headaches in general is reviewed and the current model of cervicogenic headache is critiqued. A representative case history is used to illustrate the thesis that the current model of cervicogenic headache may be too restrictive. The role of spinal manipulation as a trial of therapy in individual patients is also discussed. a retrospective diagnosis of cervical headache can often be confirmed by a successful outcome.     

都梁软胶囊联合步长脑心通治疗颈源性头痛的疗效分析

目的：分析选用都梁软胶囊联合步长脑心通治疗颈源性头痛的疗效方法选取颈源性头痛患者65例,由计算机以就诊的先后顺序随机分成两组,其中对照组32例给予步长脑心通治疗,实验组33例给予都梁软胶囊联合步长脑心通治疗,治疗后进行随访,分别用视觉模拟评分法（VAS）和抑郁状态量表（SDS）进行评分,然后对其两组评分进行对比。结果治疗后所有患者的VAS和SDS评分均低于治疗前（P＜0．05）,其中实验组均低于对照组（P＜0．05）。结论选用都梁软胶囊联合步长脑心通对治疗颈源性头痛有显著疗效。     

Quality of life of patients with cervicogenic headache: a comparison with control subjects and patients with migraine or tension-type headache

OBJECTIVE: To establish the health-related quality of life of patients with cervicogenic headache and to compare it with a random Dutch sample of control subjects and with patients with migraine without aura or with episodic tension-type headache. METHODS: Thirty-seven patients with cervicogenic headache, 42 patients with episodic tension-type headache, and 39 patients with migraine without aura completed a Medical Outcomes Study 36-Item Short Form questionnaire. RESULTS: Domain scores for "physical functioning" of patients with cervicogenic headache were worse than those of patients with migraine or tension-type headache. Physical functioning scores were lower for patients with tension-type headache than for those with migraine. Migraineurs reported a diminished score for "social functioning" compared to patients with tension-type headache. All Medical Outcomes Study 36-Item Short Form domain scores were significantly lower for patients with cervicogenic headache relative to the control group. CONCLUSIONS: Patients with cervicogenic headache have a quality of life burden that is substantial. Although impairment in the quality of life of patients with cervicogenic headache is comparable to patients with migraine without aura and those with episodic tension-type headache, there are some specific differences.     

牵引按摩改善颈源性头痛脑血管机能障碍

目的：探讨牵引按摩对颈源性头痛（CH）患者脑血管机能障碍改善的机理。方法：用经颅多谱勒超声（TCD）检测125例有颈椎曲度异常或颈椎退行性改变的颈源性头痛患者牵引按摩前后与正常对照组90例的9条颅内血管（双侧大脑前、中、后动脉、椎动脉及基底动脉），并对TCD结果做统计学分析。结果：1．颈源性头痛组（125例）牵引按摩治疗后，大脑中、前动脉的平均血流速度（Vm），较治疗前降低，其值更接近于正常对照组（P〈0．05或P〈0．01）。2．治疗后颅内成对动脉的Vm差异缩小，其代表值-非对称指数（AI）的异常率以及均值显著低于治疗前，与正常对照组更接近（P〈0．01）。结论：牵引按摩治疗可双向调整颅内动脉的异常血流速度增高和减低，从而改善颈源性头痛患者的脑血管机能紊乱。     

Cervicogenic Headache: Responses to Nitroglycerin, Oxygen, Ergotamine and Morphine

SYNOPSIS
The responses in cervicogenic headache to four different agents have been studied. Nitroglycerin was given sublingually to 27 patients. Eighteen patients got more than 20% increase of their headache. Of those with any headache increase at all, 12 got bilateral and 12 unilateral pain. The typical late cluster headache response to nitroglycerin was not seen in cervicogenic headache. The provocative effect of nitroglycerin seemed less marked in cervicogenic than in cluster headache. Oxygen inhalation, a frequently used treatment for cluster headache, was given to 14 patients with cervicogenic headache. In general, the effect seemed uncertain and probably clearly inferior to the effect in cluster headache. Ergotamine treatment (given to 13 patients) also seemed to be of little avail in cervicogenic headache. Morphine injections given to 11 cervicogenic headache patients resulted in "marked" improvement in 4, but complete pain freedom was only seen in 2 cases. In our opinion, the present results add further evidence to the view that different etiologic and pathogenetic factors underlie cervicogenic headache and cluster headache.     

The cervicogenic headache from the spiral surgery point of view--a pilot study

In a retrospective analysis of 299 consecutive patients with degenerative cervical spine disease the incidence of cervicogenic headache and the results of conservative and operative therapy have been investigated. Cervicogenic headache was noted in 117 of 299 patients (40%). 73 of those patients were treated conservatively. The cervicogenic headache resolved in 10% or improved in 27% and remained unchanged in 63% of the patients. 44 of these patients were operated by ventral discectomy, which was indicated in case of neurological deficit and painful shoulder-arm syndrome refractory to conservative treatment. In none of these patients the operation was indicated by the cervicogenic headache. In the postoperative follow-up with a mean of 6 months the headache resolved in 20%, improved in 60% and remained unchanged in 20% of the patients. These results suggest the existence of a cervicogenic headache, i.e. a headache due to disorders of the cervical spine, and the chance of successful operative treatment.     

Cervicogenic headache, migraine, and tension-type headache. Pressure-pain threshold measurements.

Pressure-pain threshold (PPT) measurements were performed with a pressure algometer, at 22 specified points in the head in patients with cervicogenic headache (n = 32), migraine (with and without aura) (n = 26) and tension-type headache (n = 17). Comparisons were made with a group of healthy controls (n = 20). The average PPT differed significantly between the groups (ANOVA, F = 9.5, P < 0.0005), largely caused by the low threshold in cervicogenic headache patients. There were no significant differences between controls and the 2 other headache groups. In the cervicogenic headache group, the lowest PPT was found in the occipital part of the head on the side with pain predominance. The ratio between the dominant and non-dominant sides (all 11 points on each side) was 0.85 in cervicogenic headache, whereas it was 0.99 in migraine patients with side preponderance of the pain. The present results support the view that the pathogenesis of cervicogenic headache differs from that of migraine and tension-type headache. The results may further support the theory that fibres from the C2 level (innervating the occipital part of the head) may be included in the pathogenetic mechanism in cervicogenic headache.     

颈源性头痛201例诊治体会

目的分析颈源性头痛的临床特点,减少误诊误治。方法回顾性分析2015年8月—2018年8月收治的颈源性头痛201例的临床资料。结果本组均为颈源性头痛,其中110例误诊,误诊率54.73%,误诊为偏头痛68例,青光眼5例,神经官能症35例,心绞痛2例,误诊时间2 d^9年,给予相应处理后症状仍反复发作。为进一步明确诊断,行相关医技检查,诊断为颈源性头痛,给予对症治疗后症状明显改善。结论颈源性头痛是一类常见疾病,提高认识、详细采集病史并及时行颈椎影像学检查是减少误诊的关键。     

Occipital Nerve Blockade for Cervicogenic Headache: A Double-Blind Randomized Controlled Clinical Trial

Abstract:   Cervicogenic headache is a chronic hemicranial pain, usually occurring daily. This randomized, double-blind, placebo-controlled trial evaluated the effectiveness of nerve stimulator-guided occipital nerve blockade in the treatment of cervicogenic headache. The reduction in analgesic consumption was the primary outcome measure. Fifty adult patients diagnosed with cervicogenic headache were randomly divided into two equal groups of 25 patients each. All patients in both groups received greater and lesser occipital blocks, whereas only 16 patients in each group received facial nerve blockade in association with the occipital blocks. The control group received injections of an equivalent volume of preservative-free normal saline. Pain was assessed using the visual analog scale (VAS) and the Total Pain Index (TPI). Forty-seven patients entered into the final analysis as three patients were lost to follow-up. Anesthetic block was effective in reducing the VAS and the TPI by approximately 50% from baseline values ( P  = 0.0001). Analgesic consumption, duration of headache and its frequency, nausea, vomiting, photophobia, phonophobia, decreased appetite, and limitations in functional activities were significantly less in block group compared to control group ( P  < 0.05). The nerve stimulator-guided occipital nerve blockade significantly relieved cervicogenic headache and associated symptoms at two weeks following injection.