Each of us has suffered from headaches in one way or another. Headaches have different localization and intensity, are accompanied by other symptoms, and have an acute and chronic course. As a rule, such pain is not a primary disease, but develops against the background of other pathologies of various etiologies.
One of the etiological causes of headaches is cervicocranial syndrome or cervicocranialgia. This pathology is classified as a neurological symptom, which is expressed in the presence of chronic recurrent pain in the patient in the occipital region and neck area. Often occurs in people over 60 years of age. It can be a consequence of head and neck injuries, including traumatic brain injury, as well as the result of a number of diseases of the spinal column.
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Among the etiological causes of the development of cervicocranial syndrome, it is customary to distinguish the following:
- protrusion or hernia of the spinal column;
- osteochondrosis;
- arthritis of various origins (rheumatoid, psoriatic, reactive);
- benign or malignant neoplasms;
- history of meningitis and/or brain abscess;
- hypertension;
- hemodynamically significant narrowing of the carotid arteries and branches;
- muscular dystrophy;
- various pathologies of skeletal bones, etc.
All pain in cervicocranial syndrome is caused by impaired cerebral circulation, which occurs for various reasons. Thus, it can be argued that this disease is not a primary, but a secondary pathology that accompanies various changes in the patient’s body. The nature of pain directly depends on the underlying disease and can be variable in nature, frequency and intensity.
Symptoms
As a result of spasm of the vertebral arteries passing in the transverse processes of the vertebrae at the cervical level, dizziness may occur. Headaches in the occipital region and neck pain appear gradually over several years. The pain is provoked by sudden turns of the head and prolonged uncomfortable position. Symptoms may worsen over time and become permanent. Patients may also be bothered by noise or ringing in the ears and/or head, dizziness, numbness of the skin of the face and neck.
An objective examination of the patient reveals a general cerebral syndrome (80%), pain on palpation of paravertebral points and spinous processes in the cervical spine, pain and tension in the cervical-occipital muscles (70%), limited range of motion in the cervical spine (70%). In 50% of cases, trigger points are identified in the neck muscles.
Features of the anatomy of the vertebral arteries
The vertebral artery is a paired blood vessel that originates from the subclavian arteries. Subsequently, both vertebral arteries (right and left) enter the foramen of the transverse process of the sixth cervical vertebra (each on its own side) and run in the bone canal formed by the transverse processes of the cervical vertebrae. Turning and tilting the head impede blood flow through the vertebral arteries, but these changes are invisible to patients with normal vascular function and the absence of additional compression factors.
In the cranial cavity, both vertebral arteries merge to form the larger basilar artery . The vertebral and basilar arteries belong to the vertebrobasilar blood supply to the brain and supply blood to the brainstem, cerebellum, cranial nerves and inner ear. Accordingly, with a decrease in the speed of blood flow through the above vessels, cerebrovascular accident syndrome in the vertebrobasilar region (VBB) may develop.
Diagnosis of cervicocranial syndrome
- Dopplerography of neck vessels.
- X-ray of the cervical spine (degenerative-dystrophic changes).
- Magnetic resonance imaging of the cervical spine (manifestations of osteochondrosis).
Differential diagnosis:
- Cervicocranialgia caused by herniated intervertebral discs.
- Cervical migraine.
- Vertebral artery syndrome.
- Neuralgia of the occipital nerve.
- Craniovertebral anomalies.
| Trigger points in the neck muscles |
ICD-10 code
The main provocateur of the development of cervicocranial syndrome is head trauma along with overload of the cervical spinal region, which can develop over a fairly long period of time. In general, the complaints include pain in the neck and head, and dizziness is not excluded.
An annoying problem that does not look serious from the outside can inform the patient about the presence of a more serious pathology in his body than cervicocranialgia. In ninety percent of cases, it is caused by osteochondrosis of the neck, requiring immediate treatment. The ICD-10 code for cervicocranial syndrome is M 53.0.
Treatment of cervicocranial syndrome
Treatment: analgesics, physical therapy, exercise therapy, drug blockades, wearing a Shants collar. Prescribed only after confirmation of the diagnosis by a medical specialist.
Essential drugs
THERE ARE CONTRAINDICATIONS. CONSULT YOUR DOCTOR.
| 1 | Diclofenac sodium (Voltaren, Diclofenac, Diclonate P) is a non-steroidal anti-inflammatory drug with an analgesic effect. |
1. Enteric-coated tablets
Start of reception
It is recommended to take the drug immediately after the first symptoms of the disease. The duration of treatment depends on the overall clinical picture and the dynamics of symptoms (usually the course of treatment is several days). In the absence of severe pain (in mild cases of the disease), you should start with a dosage of 75-100 mg per day. In more complex cases, a dose of 100-150 mg per day is recommended.
How to use
The drug must be taken in several doses (each time before meals). Swallow the tablets whole with liquid. For severe night pain or morning stiffness, supplement treatment with diclofenac in the form of a suppository (take before bed).
Dosage (amount of drug per day)
| maximum | 150 mg |
| initial | from 50 to 100 mg |
| for rheumatoid arthritis | increase by 3 mg per kilogram of body weight |
| during the menstrual cycle | increase to 150 mg |
| with primary dysmenorrhea | determined individually (usually about 50-150 mg) |
For children
For children weighing ≥ 25 kg, give the drug in two or three doses, depending on the severity of the disease, at a rate of 0.5 to 2 mg per 1 kilogram of body weight (per day).
2. Extended-release film-coated tablets
Dosage
An initial dose of 100 mg (or one extended-release tablet) per day is optimal for initiation, as well as for the treatment of relatively mild cases of disease or long-term therapy.
How to use
Take the medicine with food, swallowing the tablets whole. If pain is severe in the morning or evening, it is recommended to take pills at night.
For children
Extended-release tablets should not be prescribed to children.
4. Rectal suppositories
Start of reception
You should start with a dose of 100-150 mg per day. The drug should be taken immediately after the symptoms of the disease appear. For the treatment of relatively mild cases of disease or for long-term therapy, the optimal dose is 75-100 mg per day. The amount of the drug taken per day should be divided into two or three parts and taken, respectively, in two or three doses.
With severe pain syndrome
Additionally, take diclofenac in suppositories. Drink at night before bed. The total daily dose is no more than 150 mg.
Dosage (amount of drug per day)
| maximum | 150 mg |
| initial | from 50 to 100 mg |
| initial for migraine | 100 mg |
| during the menstrual cycle | increase to 150 mg |
| with primary dysmenorrhea | determined individually (usually about 50-150 mg) |
| for juvenile rheumatoid arthritis | increase to 3 mg per kilogram of body weight |
A course of treatment
Individual (several days). The duration of treatment depends on the overall clinical picture and the dynamics of symptoms.
For children
Take two to three times a day depending on the severity of the disease. Dose calculation: 0.5 to 2 mg per 1 kg of body weight for children weighing ≥ 25 kg.
Attention! Children should not be prescribed 50 and 100 mg suppositories.
5. Solution for intramuscular administration
How to enter
Deep injection into the buttock. Inject the drug carefully so as not to get into the nerve or other tissues. The optimal point for administering the drug is the upper square of the buttock.
Dosage
| for migraine | take immediately after the onset of an attack; administer intramuscularly; dosage - 75 mg |
| maximum starting dose | 175 mg |
| daily dose | 75 mg (or one ampoule) |
Treatment of severe cases
Increase the dose to 2 injections per day of 75 mg at intervals of several hours. In this case, the second injection is carried out in the opposite gluteal muscle. You can combine the first injection with disclofenac in other forms (rectal suppositories or tablets). The total dosage of medications is no more than 150 mg.
A course of treatment
No more than two days in a row*.
* You can continue treatment with the same drug in a different form (diclofenac tablets or rectal suppository).
| 2 | Tizanidine (Tizanidin-Teva, Tizalud, Sirdalud) is a centrally acting muscle relaxant. |
| How to use | How much to take | |
| with muscle spasm | inside | 2-4 mg three times a day, for severe pain - an additional 2-4 mg at night |
| with spasticity of skeletal muscles | take three times a day, increase the dosage gradually by 2-4 mg every 3-7 days, it is possible to obtain a good therapeutic effect when taking the drug in a daily dose of 12-24 mg in three or four doses after an equal amount of time | initial recommended dose: no more than 6 mg, maximum dose per day: 36 mg |
| for renal failure | increase the dosage gradually, based on the clinical picture, tolerability of the drug and the effectiveness of its use | initial recommended dose: 2 mg once daily |
Causes
Cervicocranialgia, as a rule, develops against the background of impaired blood circulation. The brain simply stops receiving the portions of oxygen it requires, and as a result, serious pain occurs. As they say in medicine, the reflex nature of the disease begins to manifest itself. Another common factor in cervicocranialgia is pinched nerve endings, which is usually accompanied by absolute destruction of cartilage tissue. In this case, swelling and inflammation can have an adverse effect on the nerve roots, which manifests itself in discomfort. This syndrome is called radicular.
Cervicocranial syndrome (according to ICD - M53.0) is considered far from an independent pathology. It is a set of symptoms that lead to the formation of cervicocranialgia. Its indirect causes can also be considered inflammatory processes in the form of hernia, osteochondrosis and spondylosis, pathologies of the heart, lungs, and at the same time previously received injuries. Next, let's talk about the symptoms of cervicocranial syndrome.
Recommendations
A consultation with a neurologist and x-ray of the cervical spine with functional tests are recommended.
| • | Leading specialists and institutions for the treatment of this disease in Russia: |
| Doctor of Medical Sciences, Head of the Department of Russian State Medical University, Professor, Academician of the Russian Academy of Medical Sciences Gusev E.I. | |
| • | Leading specialists and institutions for the treatment of this disease in the world: |
| G. AVANZINI, Italy. |
Types of pathology
Cervicocranialgia is divided into a number of types, which differ from each other in their following symptoms:
- Vertebrogenic type, accompanied by severe dizziness in combination with the appearance of dark spots in the eyes, nausea and migraine. Against this background, the cause, as a rule, is poor blood circulation in the cervical region.
- The chronic type is a hypertensive syndrome in which characteristic pressing and bursting pain is observed.
- A syndrome accompanied by pinched spinal nerves. In this case, a person’s head hurts only on one side, and has a clearly defined character.
Incidence (per 100,000 people)
| Men | Women | |||||||||||||
| Age, years | 0-1 | 1-3 | 3-14 | 14-25 | 25-40 | 40-60 | 60 + | 0-1 | 1-3 | 3-14 | 14-25 | 25-40 | 40-60 | 60 + |
| Number of sick people | 0 | 0 | 0.3 | 18 | 18 | 30 | 36 | 0 | 0 | 0.3 | 18 | 18 | 30 | 36 |
Prevention
It is very difficult to prevent and prevent cervicocranial syndrome (according to ICD-10: M53.0), however, you can reduce the risks of its occurrence or significantly alleviate its course. To do this, it is recommended to listen to the following tips:
- Perform a set of exercises that can relieve muscle tension.
- From time to time you should stretch your neck muscles to strengthen them.
- It is imperative to maintain correct posture.
- When working on a computer, you need to place the monitor at eye level.
- When sleeping, you need to place your head on the pillow and your shoulder on the mattress.
You need to try to completely eliminate “aggressors” from your life, who often provoke certain stressful situations, and if you can’t do this, then you need to learn to switch from the current problem to some pleasant moments.