Decompression of the greater occipital nerve improves outcome in patients with chronic headache and neck pain — a retrospective cohort study

Background Compression of the greater occipital nerve (GON) may contribute to chronic headache, neck pain, and migraine in a subset of patients. We aimed to evaluate whether GON decompression could reduce pain and improve quality of life in patients with occipital neuralgia and chronic headache and neck pain. Methods In this retrospective cohort study, selected patients with neck pain and headache referred to a single neurosurgical center were analyzed. Patients (n = 22) with suspected GON neuralgia based on nerve block or clinical criteria were included. All patients presented with occipital pain spreading frontally and to the neck in various degree. Surgical decompression was performed under local anesthesia. Follow-up was made by an assessor not involved in the treatment of the patients, by telephone 2–5 years after the surgical procedure and an interview protocol was used to collect information. The data from the follow-up protocols were then analyzed and reported. Results When analyzing the follow-up protocols, decreased headache/migraine was reported in 77% and neck pain was reduced in 55% of the patients. Conclusions Decompression of GON(s) may reduce neck pain and headache in selected patients with persistent headache, neck pain, and clinical signs of GON neuralgia. Based on the limitations of the present retrospective study, the results should be considered with caution.

Factors associated with headache and neck pain among telecommuters – a five days follow-up

Background The current sanitary crisis brought on by the COVID-19 recently forced a large proportion of workers to adopt telecommuting with limited time to plan transition. Given that several work-related risk factors are associated with headache and neck pain, it seems important to determine those associated with headache and neck pain in telecommuters. The main objective of this study was to identify which telecommuting and individual associated factors are related with headache and neck pain occurrence in telecommuters over a five days follow-up. The second objective was to evaluate the impact of wearing a headset on headache and neck pain intensity in telecommuters. Methods One hundred and sixty-two participants in telecommuting situation were recruited. Baseline assessment included sociodemographic data, headache and neck pain-related disability (6-item Headache Impact Test (HIT-6) and Neck Bournemouth Questionnaire (NBQ)), headache and neck pain frequency and intensity as well as questions about the wearing of a headset (headset wearing, headset type and headset wearing hours). A prospective data collection of headache, neck pain and headset wearing was conducted using daily e-mail over a 5-day follow-up. A stepwise multivariate regression model was performed to determine associated factors of headache or neck pain occurrence during the follow-up. A t-test was conducted to assess the impact of headset wearing on headache and neck pain intensity during the follow-up. Results Regarding headache, the stepwise multivariate regression model showed that the HIT-6 score was associated with future headache occurrence in telecommuters (OR (95% CI) = 1.094 (1.042–1.148); R2 = 0.094; p < 0.001). For neck pain, the stepwise multivariate regression showed that the NBQ score was related to future neck pain occurrence in telecommuters (OR (95% CI) = 1.182 (1.102–1.269); R2 = 0.182; p < 0.001). T-test showed no difference between participants that wore a headset and participant that did not wore a headset on mean headache (p = 0.94) and neck pain (p = 0.56) intensity during the five days follow-up. Conclusion Although several work-related risk factors are associated with headache and neck pain in workers, telecommuting did not present the same risks. Working set-up did not have a significant impact on headache and neck pain as headache-related disability was the only associated factor of future headache episodes and neck-pain related disability was the only associated factor of future neck pain episodes. Also, wearing a headset had no impact on headache and neck pain in telecommuters.

Basilar Artery Occlusion. Clinical Evaluation and Contemporary Methods of Treatment

Acute occlusion of the basilar artery and its branches is a frequent cause of posterior circulation strokes. Although it accounts for only 1 to 3 % of ischemic strokes, it is a potentially life-threatening condition associated with high mortality rates. Exact clinical diagnosis is still challenging because symptoms such as vertigo, dizziness followed by headache, and neck pain are nonspecific and usually attributed to many other neurological diseases. The onset of symptoms can be abrupt or gradual and progressive. Establishing the time of symptoms onset and making a timely diagnosis is highly important. In case the diagnosis is made promptly, ideally with the help of an advanced neuroimaging, intravenous thrombolysis, or catheter-based endovascular treatment can be performed immediately to improve prognosis and reduce mortality.

Neck Pain- and Unsteadiness-Inducing Activities and their Relationship to the Presence, Intensity, Frequency, and Disability of Headaches

(1) Background: Headache is a significant public health problem. Despite the association between headache and neck pain, little is known about the relationships among specific activities that generate neck pain and headache. The aim of this study was to identify the specific activities that result in neck pain and unsteadiness, and determine how they are linked to headache in university students. (2) Methods: One hundred and six patients with physician-diagnosed headache and 92 healthy university students completed surveys assessing demographics; the presence, frequency, intensity, and disability of headaches; and activities generating neck pain and unsteadiness. (3) Results: The presence of headache was related to female gender (p = 0.001), neck pain when reading or watching television (p = 0.024), and unsteadiness when moving the head (p = 0.005). Headache-related disability was associated with intensity of neck pain (p < 0.001), neck pain when reading or watching television (p = 0.033), and stumbling (p < 0.001). Headache frequency was related to smoking (p = 0.004), the duration of neck pain-associated symptoms (p = 0.047), and neck pain when driving (p = 0.039). Intensity of headache was associated with female gender (p = 0.002), smoking (p = 0.013), and neck pain-related sleep alterations (p = 0.024). (4) Conclusions: Female gender, smoking, neck pain, and unsteadiness when moving the head are factors related to headache in university students.

Validation of a clinical examination to differentiate a cervicogenic source of headache: a diagnostic prediction model using controlled diagnostic blocks

ObjectivesNeck pain commonly accompanies recurrent headaches such as migraine, tension-type and cervicogenic headache. Neck pain may be part of the headache symptom complex or a local source. Patients commonly seek neck treatment to alleviate headache, but this is only indicated when cervical musculoskeletal dysfunction is the source of pain. Clinical presentation of reduced cervical extension, painful cervical joint dysfunction and impaired muscle function collectively has been shown to identify cervicogenic headache among patients with recurrent headaches. The pattern’s validity has not been tested against the ‘gold standard’ of controlled diagnostic blocks. This study assessed the validity of this pattern of cervical musculoskeletal signs to identify a cervical source of headache and neck pain, against controlled diagnostic blocks, in patients with headache and neck pain.DesignProspective concurrent validity study that employed a diagnostic model building approach to analysis.SettingHospital-based multidisciplinary outpatient clinic in Joliet, Illinois.ParticipantsA convenience sample of participants who presented to a headache clinic with recurrent headaches associated with neck pain. Sixty participants were enrolled and thirty were included in the analysis.Outcome measuresParticipants underwent a clinical examination consisting of relevant tests of cervical musculoskeletal dysfunction. Controlled diagnostic blocks of C2/C3–C3/C4 established a cervical source of neck pain. Penalised logistic regression identified clinical signs to be included in a diagnostic model that best predicted participants’ responses to diagnostic blocks.ResultsTen of thirty participants responded to diagnostic blocks. The full pattern of cervical musculoskeletal signs best predicted participants’ responses (expected prediction error = 0.57) and accounted for 65% of the variance in responses.ConclusionsThis study confirmed the validity of the musculoskeletal pattern to identify a cervical source of headache and neck pain. Adopting this criterion pattern may strengthen cervicogenic headache diagnosis and inform differential diagnosis of neck pain accompanying migraine and tension-type headache.

Predictors of Ischemic Events Secondary to Cervicocerebral Artery Dissection

Objective : To identify the predictors of ischemic events secondary to cervicocerebral artery dissection (CAD). Methods : Consecutive patients with cervicocerebral artery dissection from 2010 to 2017 were registered as study subjects, who were classified as patients with and without ischemic events. Clinical data were collected prospectively, such as demographics, vascular risk factors, headache and neck pain, dissection site and laboratory test. A case-control study was performed to compare the clinical data between two groups. Results : A total of 130 patients with cervicocerebral artery dissection were included, in which 70.0% (91/130) suffered from ischemic events, including 81 ischemic strokes and 10 transient ischemic attacks. There were 46.2% (42/91) and 25.6% (10/39) of the artery dissections located in the anterior circulation in the CAD patients with and without ischemic events respectively ( p =0.029). The average level of HDL was (1.14±0.38) mmol/L in the CAD patients with ischemic events, and (1.28±0.48) mmol/L in the CAD patients without ischemic events ( p =0.083). Multivariate logistic regression analysis showed that there was a positive correlation between anterior circulation and ischemic events (OR=3.204, 95% CI 1.305-7.863, p =0.011) and HDL level was negatively correlated with ischemic events (OR=0.335, 95% CI 0.130-0.867, p =0.024) in CAD patients. Conclusion : Ischemic events are common complications of cerebrovascular disease in CAD patients, especially for those with an artery dissection located in the anterior circulation and low serum HDL level. Key Word : cervicocerebral artery dissection, ischemic event, HDL, anterior circulation, predictor

Predictors of Ischemic Events Secondary to Cervicocerebral Artery Dissection

Objective: To identify the predictors of ischemic events secondary to cervicocerebral artery dissection (CAD). Methods: Consecutive patients with cervicocerebral artery dissection from 2010 to 2017 were registered as study subjects, who were classified as patients with and without ischemic events. Clinical data were collected prospectively, such as demographics, vascular risk factors, headache and neck pain, dissection site and laboratory test. A case-control study was performed to compare the clinical data between two groups. Results: A total of 130 patients with cervicocerebral artery dissection were included, in which 70.0% (91/130) suffered from ischemic events, including 81 ischemic strokes and 10 transient ischemic attacks. There were 46.2% (42/91) and 25.6% (10/39) of the artery dissections located in the anterior circulation in the CAD patients with and without ischemic events respectively (p=0.029). The average level of HDL was (1.14±0.38) mmol/L in the CAD patients with ischemic events, and (1.28±0.48) mmol/L in the CAD patients without ischemic events (p=0.083). However, no significant differences were found in the other clinical data. Multivariate logistic regression analysis showed that there was a positive correlation between anterior circulation and ischemic events (OR=3.204, 95% CI 1.305-7.863, p=0.011) and HDL level was negatively correlated with ischemic events (OR=0.335, 95% CI 0.130-0.867, p=0.024) in CAD patients. Conclusion: Ischemic events are common complications of cerebrovascular disease in CAD patients, especially for those with an artery dissection located in the anterior circulation and low serum HDL level. Key Word: cervicocerebral artery dissection, ischemic event, HDL, anterior circulation, predictor

Decoding vestibular migraine for easier diagnosis

<p class="abstract"><strong>Background:</strong> Due to the absence of a unified set of diagnostic criteria, vestibular migraine is always an underdiagnosed entity. This study was undertaken to find specific pointers in the diagnostic protocol which can help in diagnosing vestibular migraine and also to assess our treatment module for vestibular migraine.</p><p class="abstract"><strong>Methods:</strong> An elaborate proforma was prepared for evaluating each patient at our vertigo clinic for a time period of two years. A detailed history is followed by general examination, ENT examination, specific tests for eyes, tests for vestibulospinal tract, and also a few more tests such as Doppler, pure tone audiogram, ECHO etc. when the diagnosis was in doubt. A total of 206 patients were evaluated. Vestibular migraine cases were started on our drug regimen of Tab flunarizine once daily and subjected two follow ups (at 4 weeks and 12 weeks). </p><p class="abstract"><strong>Results:</strong> Total of 20 patients (9.7%) diagnosed as vestibular migraine. There was a slight preponderance to female population. A positive history of recurrent headache and neck pain were definitive clinchers in diagnosing vestibular migraine. All 20 patients had alleviation of symptoms with regards to severity and frequency of episodes.</p><p class="abstract"><strong>Conclusions:</strong> Detailed history and elaborate vestibular examination alone is necessary for diagnosing vestibular migraine. Flunarizine regimen for a period of 3 months is found to be effective in relieving the symptoms. Adjuvant vestibular rehabilitation exercises mandatory for total alleviation of symptoms.</p>