Headaches With Osteochondrosis Of The Cervical Spine: Symptoms And Treatment

2024 Author: Rachel Wainwright | [email protected]. Last modified: 2024-01-15 19:51

Headaches with osteochondrosis of the cervical spine

The content of the article:

1. Features of headaches in osteochondrosis of the cervical spine
2. Symptoms

3. Treatment

   1. Drug treatment
   2. Other methods of conservative therapy
   3. Surgery
4. Video

Headaches with osteochondrosis of the cervical spine have a special name. Cervicogenic headache (CBH) is a pain syndrome caused by diseases of the cervical spine and spreads from the occipital region to the front of the head. Often it has a clear relationship with movements in the cervical spine and is a complex of cervic-brachial pain sensations, vestibular and autonomic disorders. In addition to this pain syndrome, there is also muscle-fascial pain dysfunction (pain muscle dysfunction), which is difficult to distinguish clinically from cervical pain and rather serves as its complement, but arises for other reasons (muscle overstrain, local spasm).

Headache is the main symptom of cervical osteochondrosis

Features of headaches in osteochondrosis of the cervical spine

1. Painful sensations are spontaneous, usually triggered by mechanical factors (sleep in an uncomfortable position; prolonged physical activity).
2. It can radiate to adjacent structures (shoulder, arm, scapula), which complicates differential diagnosis.
3. More common in women.
4. The elements of the intervertebral disc, the cartilaginous surfaces of the vertebrae, the musculo-ligamentous apparatus, the vessels and nerves are simultaneously involved (multisymptomatic state).
5. Pronounced processes of cerebral ischemia due to hypoxia.
6. It is one-sided (total distribution rarely occurs).
7. Typical manifestations of autonomic syndrome at the height of a headache attack (it is necessary to differentiate with a migraine attack).
8. It occurs more often in degenerative-dystrophic diseases at the C2-C3 level (synchronous irritation of the motor and sensory roots).
9. Clear diagnostic signs of osteochondrosis at any stage of development (chondrosis, disc instability, intervertebral hernia, fibrosis).
10. At the heart of the switching of pain from the side of the neck to the side of the head is the convergence between the branches of the trigeminal and occipital nerves, as well as compression of the vessels by deformed vertebrae / elements of the intervertebral disc (vertebral artery syndrome arises as a component of cervicogenic headache).

There are modified diagnostic criteria for cervicogenic headache (Sjaastad O. 1998), which indicate the severity of the condition:

1. Symptoms of neck involvement (headache when moving in the cervical spine; with external pressure on the occipital region on the sympathetic side). Limitations of range of motion in this segment of the spine.
2. Ipsilateral pain of an indeterminate (non-radical) nature in the neck, shoulder, arm, or sometimes pain in the arm of a radicular nature.
3. Confirmation of the disease with a diagnostic analgesic blockade, after which the pain disappears.
4. Painful sensations on one side of the head without changing sides.
5. The specific nature of the headache (moderate or severe, non-pulsating, mild, usually starting in the neck; episodes of pain have varying duration; fluctuating, prolonged pain).

Other characteristics of secondary importance (continued classification):

• partial or lack of effect when taking indomethacin;
• partial or lack of effect when taking sumatriptan;
• female;
• a history of neck injuries.

Other characteristics (from the category of optional) include various phenomena that are associated with an attack and rarely occur (nausea, fear of sound, photophobia, dizziness, edema of the periocular region).

Due to the peculiarities of localization, a number of difficulties arise in the timely diagnosis and often requires a long diagnostic search.

Symptoms

The clinical picture of this pain syndrome has extremely versatile manifestations.

Symptom	Manifestations
Pain	1. It usually occurs during the daytime and can last from 1 to 6 hours. 2. The maximum level of stiffness is observed in the morning (the patient's head is in a forced position for some time). 3. Has no pronounced intensity. 4. Pain syndrome can be provoked by examination (pressure on the points of attachment of muscle tendons in the occipital region and pressure along the greater and lesser occipital nerves). This is an important diagnostic difference that allows the first stage of differentiation with other pathologies. 5. Soreness can begin not only in the cervical segment itself, but also in the upper extremities (brachialgia may not have a pronounced dependence on headaches and occur at any time interval). 6. The classical clinical picture is presented by painful sensations always arising on one side of the head and combined with ipsilateral pain.
Movement	Decrease in the volume of active and passive movements not only in the cervical segment of the spine, but also in the region of the lower jaw, shoulder joints.
Muscle tension	On physical examination, a tense muscle bundle is palpated. When stretching, the soreness decreases slightly. In the case of exposure to the nerve plexuses (trigger points), a sharp muscle contraction occurs, accompanied by severe pain.
Photophobia	The appearance of unpleasant sensations even with minor light stimuli.
Vestibular manifestations	Associated with the occurrence of nausea, vomiting, impaired coordination of movements, dizziness.
Other clinical manifestations	· Soreness in the area of teeth, gums, masticatory muscles, temporomandibular joint, sinuses of the facial part of the skull; · Cramps and trismus of facial muscles.

The phenomena of cervicogenic headache are paroxysmal in nature.

The listed additional manifestations occur either simultaneously with the headache, or with a slight delay. The disease has a pronounced tendency to chronicity.

Treatment

Treatment of headaches with osteochondrosis is associated with a specific stage of its development.

1. Chondrosis - the first stage of the disease, is associated with damage only to the internal structures of the intervertebral disc. Therapy is conservative (patients rarely seek help at this stage due to the lack of expression and non-specificity of the clinic).
2. Instability of intervertebral structures. At this stage, headaches may occur (in 30-40% of cases). Treatment is conservative due to the absence of pronounced deformation of the annulus fibrosus (the structure of the disc is destroyed throughout, but the articular surface does not protrude into the surrounding space).
3. The stage of hernia formation. The classic period of the onset of complaints of headache and other related manifestations. There is an anatomical violation of the integrity of the intervertebral joint and protrusion of the disc elements into the surrounding space, which is why, in addition to conservative techniques, surgical treatment is allowed.
4. Fibrosis stage. A complaint about cervical headache becomes chronic with periods of exacerbation. It can be treated both conservatively and surgically (the attending physician chooses a specific patient management regimen).

Drug treatment

Group of drugs	Features:	A drug
Non-steroidal anti-inflammatory drugs (the most commonly used drugs in practice)	Use is permissible both locally (ointments, gels) and at the systemic level (tablets, injections). The action is based on anti-inflammatory effects (inhibition of prostaglandin synthesis). A special group is made up of non-selective blockers COX 1, COX 2, since their use leads to pronounced muscle relaxation (they also prevent psycho-emotional overstrain). The use is permissible only in the acute phase of the disease, as pain decreases, the reception turns.	Celebrex, Diclofenac, Ibuprofen, Ketorol, Meloxicam.
Analgesics	Various narcotic and non-narcotic drugs with various types of administration (intravenous, intramuscular, oral) for the purpose of pain relief. Applied relatively rarely, given the low efficiency. Quickly addictive, which reduces the effect of the drug by 30-40%. Strong narcotic analgesics are often required to achieve the desired effect.	Tramadol, Naloxone.
Vasodilators (vasodilators)	Provide some expansion of spasmodic vessels and connection of collateral blood circulation.	Actovegin, Cytoflavin.
Muscle relaxants	Used for muscle-fascial pain dysfunction (muscle spasm). Severe relaxation, depending on the type of drug, has a different duration.	Clonazepam, Tizanidine, Baclofen, Midocalm.
Antidepressants and anticonvulsants	They have a pronounced anticonvulsant, Antipsychotic effect. Provides a tendency to stabilize muscle tone.	Amitriptyline, Carbamazepine, Gabapentin.
Anesthetic blockade	They can be carried out in the suproorbital region, the region of the greater occipital nerve, as well as in the projection of the roots C2, C3 (more often done in the region of the inferior oblique muscle at the exit of the greater occipital nerve). The blockade has an effect not only directly on the cervical segment, but also on the frontotemporal-orbital region (anesthesia occurs outside the area of the injection itself, but also in the innervated areas).	2% solution of Lidocaine and Dexamethasone, sometimes with the inclusion of Actovegin.

Ibuprofen can be used to treat headache in osteochondrosis, but only for a short course during exacerbations

Other methods of conservative therapy

Physiotherapy. At the moment, various procedures are used with different directions of action. Most often used:

• radiofrequency neurotomy (denervation of the upper cervical roots eliminates the source of pathological pain); ultrasonic exposure;
• electrophoresis with novocaine;
• sinusoidal idiadynamic currents;
• mud applications.

Any impact is on the paravertebral zone on the neck and relieves the patient from pain (not completely and not completely).

Exercise therapy. The main purpose of the exercise is to stretch and warm up the muscle tissue. A set of exercises can be done at home, taking into account the mild course of the disease. The classic option is isometric stretching (you need to do it every day to achieve the effect).

Massage. It helps to effectively relieve muscle spasm and has a relaxing effect. Practical training of patients with chronic pain for self-massage at home is allowed.

Orthopedic devices. These include, first of all, the Chance collar, which provides additional support and support to the affected area. In addition, bandages and corsets are used to limit range of motion for prophylactic purposes. It is required to wear a corset for a strictly defined time on the recommendation of a specialist, since with constant use, atrophy of muscle structures occurs (at night it is necessary to remove it).

Bed rest. It is indicated for acute pain, used in combination with immobilization of the cervical spine for several days.

Surgery

Surgical techniques are associated with the elimination of the cause of compression of blood vessels and nerves, that is, they have a therapeutic effect in relation to headaches indirectly.

Surgical techniques include:

• decompression of the roots;
• separation of adhesions that arise near large vessels and nerves;
• chemical shutdown (dereception) of the nerve plexuses of the disc using chemical compounds;
• microdiscectomy for damaged intervertebral hernia;
• stabilization of disc participants with bone grafts;
• arthroplasty in the case of severe fibrosis of the articular surface with complete loss of function.

Surgical treatment is resorted to in the absence of positive dynamics for 2-3 months of treatment.

Video

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Anna Kozlova Medical journalist About the author

Education: Rostov State Medical University, specialty "General Medicine".

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