頸原性頭痛の臨床

Clinical Aspects of Cervicogenic Headache

頸原性頭痛は頸部疾患を原因とする，原則的には片側性の非拍動性頭痛を呈する症候群であり，慢性頭痛の15〜20％を占める。頸部より始まり，後頭部から前頭部，眼窩周囲に放散し，患側の頸肩腕痛を伴う。三叉神経脊髄路尾側亜核で，上位頸神経が三叉神経と収束することが関与すると考えられているが，この説では説明できない中下位頸椎疾患による頭痛も多数報告され，これらが新たな病型である可能性を提唱した。薬物に対する治療抵抗例も多く，複数の治療を組み合わせた集学的治療アプローチが必要である。

Abstract

Cervicogenic headache (CEH) is a lateralized non-pulsative headache syndrome caused by cervical spine disorders. The headache is initiated in the neck, which subsequently spreads to the occipital, frontal, and orbital regions, and is accompanied by ipsilateral shoulder pain. The prevalence of CEH is considered to be 15-20% among cases of chronic headache. With regard to the mechanism of CEH, convergence of upper cervical nerves and trigeminocervical complex might play an important role. However, CEH in many patients has been reported to be associated with middle to lower cervical disorders, which cannot be explained by this theory. We therefore proposed the possibility that the condition reported here is another type of CEH. The treatment of CEH requires a multidisciplinary approach, because pharmacological treatment is often ineffective.

(Received August 16 2019; Accepted November 25, 2019; Published March 1, 2020)