Pain of migraine headaches

Specific symptoms of the cervicogenic headache are a unilateral headache that does not change sides.
Pain levels are from moderate to severe intensity and are characterized by a dull or dragging-piercing quality.
The majority of studies were performed in headache centers, where the incidence rate varied between 1-15 %.
Peripheral nerve fibers reach into the spinal cord from the back of the head and the neck, where they mix with spinal cord fibers. Known causes, such as basilar impression, transitional anomalies, rheumatoid arthritis, cervical myelopathy, bony tumors, neurinomas at the height of C1-C2, venous plexus, arterial vascular loops, arteriovenous malformations, a dissection of the vertebral artery and in rare cases of the internal carotid artery as well, or unilateral retropharyngeal tendinitis must be differentiated from unknown causes through precise clinical studies. Blockages of the greater occipital nerve are technically easier to perform, have fewer side effects, and constitute an alternative to C2 blockages. There are no systematic studies that allow for classification according to evidence-based medicine.
It presents itself almost exclusively as a continuous, permanent pain fluctuating in intensity, and may be superimposed by attacks with durations lasting from several hours to several days.
This morphologic and functional mixing of peripheral nerves and spinal cord fibers in the sense of a “relay” is responsible for the transmission of pain impulses from the neck to the forehead.

Furthermore, transcutane electrical nerve stimulation (TENS), physical measures such as massages, hydrotherapy, or electrotherapy, as well as therapy approaches combined with physiotherapeutic and cognitive-behavioral therapeutic measures are applied.
In cases of clinically unambiguous diagnoses, neurolyses of the greater occipital nerve only showed a lasting effect over more than 16 months in 8 % of patients. Sometimes, attendant symptoms such as nausea and vomiting, unspecified dizziness, isolated sensitivity to sound and light, and swallowing disturbances (only rarely) are observed.
Almost all study authors stated that women suffer from cervicogenic headaches more than men by a ratio of 3:2. Nerve or root blockages (the paracervical block according to Moore and the C2 ganglion block according to Bogduk) probably only have a diagnostic value. The examined patient population is inhomogeneous, not clearly defined, and contains some patients with unilateral discomforts and others suffering from bilateral complaints as well. In a differentiated application of the ganglionectomy, as well as ventrally and dorsally decompressing surgeries, success rates of 80 % were described in an overview including 102 patients.

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