Pain in the back of the head - cervical migraine

Migraine pain occurs due to swelling of an area of ​​the brain

, which is caused by a sharp narrowing (spasm) and then expansion of its vessels.
According to statistics, in most cases, migraine affects the young population
(under 30 years of age).
And most often this terrible disease falls on the fragile shoulders of the weaker sex, although in childhood it is more common in boys. After 60 years, the course of the disease becomes easier, but in middle years it reaches its peak
.

Causes of a migraine attack

Migraine occurs for various reasons:

1. First of all, this is, of course, a genetic predisposition
   (it is transmitted mainly through the female line, but is often found in men).
2. Migraines can also occur due to various types of brain injury
   (for example, after a car accident).

The following factors contribute to the occurrence of an attack:

• sleep disturbances or deficiency;
• emotional stress, stress and fatigue;
• frequent consumption of coffee, chocolate and low-alcohol drinks (wine, beer, champagne).

Forms of migraine

There are different forms of migraine: basilar migraine, retinal migraine, ophthalmoplegic migraine and so on, but the most important ones are with
and
without aura
. Migraine with aura occurs in less than 25% of cases. Migraine without aura is much more common. Aura is those symptoms that appear before or along with pain and are reversible.

There are different types of aura:

• visual - hallucinations and distortion of the perception of objects (most common),
• hemiparesthetic - numbness or showing of the limbs (skin sensitivity),
• hemiparetic - impaired motor functions (weakness, fatigue, drowsiness),
• dysphasic - impaired speech function (slurred/confused speech),
• mixed - a combination of several types.

How to distinguish a migraine from a regular headache?

The main symptom of migraine is the locality of the pain. As a rule, this is an intense throbbing pain in the frontal lobe, only on one side
. The localization of pain is mainly more focused on the eye area and temporal region.

But there are also other signs:

• frequent dizziness;
• poor appetite and nausea;
• vomiting with severe pain;
• fatigue and drowsiness;
• anxiety and depression;
• numbness of the limbs;
• severe irritability and sensitivity to bright lights, smells and sounds.

Cervical migraine or Barré-Lieu syndrome

Barré-Lieu syndrome (cervical migraine, vertebral artery or vertebral sympathetic nerve syndrome) is a complex of symptoms that occurs when the vertebral artery or the vertebral nerves surrounding it are compressed. The pathology is characterized by severe pain in the head, neck, disorders of visual, auditory and vestibular functions.

As a rule, pain begins from the upper part of the neck, then moves to the occipital and parietal parts of the head, and then can radiate to the temporomygomatic lobes. Quite often the pain is unilateral, but bilateral lesions can also occur.

For the first time, compression of the nerve roots around the vertebral arteries and the associated symptoms were described by the French physician Barre and his colleague Lieu in 1925. It is precisely because of severe paroxysmal pain, accompanied by sensations of squeezing of the head, bulging of the eyeballs, a burning sensation or spreading coldness in the brain, that the pathology received its second name - cervical migraine.

Anatomy and etiology of the disease

The vertebral arteries are paired formations that arise from the subclavian arteries and enter the transverse foramina of the sixth cervical vertebra. Blood lines run in a canal formed by openings located on the sides of the cervical vertebrae in the transverse processes. The vertebral veins pass next to the arteries.

Having emerged from the opening of the first cervical process of the artery, they sharply change their direction, describing an arc, bend around the atlas from behind and from the side and go along a deep groove. Then they pass through the foramen magnum and the posterior cranial fossa, piercing the atlanto-occipital membrane and the dura mater of the brain, where they unite into the unpaired basilar artery, located in the sulcus of the bridge.

The basilar vessel supplies blood to the pons, cerebellum and posterior parts of the brain. In addition, it is involved in the process of vascularization (restoration, formation of new blood vessels) of the anterior parts of the brain, providing replacement in case of disruption of arterial blood flow from the carotid arteries.

In the cervical region of the spine, multiple spinal branches depart from the arteries, which penetrate through the intervertebral foramina into the canal of the spinal column and entwine the nerve roots. Considering the rather thin and delicate muscular structure of the cervical spine, it is no secret that the vertebral arteries are subject to high traumatism. While passing through the transverse canal, the arteries must slide freely, repeating the corresponding bends and changes in the direction of the channel, while the slightest inconsistencies of one vertebral body relative to another can lead to deformation of the vessels.

Any infringement of the cervical arteries disrupts blood circulation and lymph flow in the upper spine and brain. In the pathological area, swelling, spasm of soft tissues and compression of nerve endings are formed, which immediately affects the sensitivity and functionality of the upper extremities. Thus, by understanding the basic role of the vertebral arteries, the importance of maintaining their integrity can be explained.

Causes of Barré-Lieu syndrome

Factors influencing the occurrence of the disease are usually divided into two categories: vertebrogenic (related to the spine) and non-vertebrogenic (not related to pathologies of the spinal column).

Vertebrogenic:

• degenerative-dystrophic changes in the body or osteochondrosis;
• age-related changes in bone architecture or osteoporosis;
• traumatic injuries of the cervical spine;
• curvature of posture or scoliosis;
• spondylosis;
• proliferation of osteophytes;
• arthritis or arthrosis of intervertebral joints;
• developmental anomalies of the cervical vertebrae (for example, Kimmerly’s anomaly, high location of the vertebral processes, etc.);
• hereditary structural anomalies, postpartum injuries, etc.

Nonvertebrogenic:

• vascular atherosclerosis;
• thrombophlebitis;
• stenosis of the walls of blood vessels;
• anomalies in the development of the vertebral arteries or their branches from the subclavian bed;
• soft tissue tumors;
• cervical lymphadenitis, etc.

Symptoms of the disease

The main symptom of the disease is an acute throbbing headache. It often spreads to the frontal region, eyes, ears, and can cover the spinal column (sometimes up to the lumbar region), shoulders, upper chest, and upper limbs.

In some cases, unpleasant sensations may be localized mainly in the frontal and parietal zones, with little manifestation in the occipital region or neck. Many patients complain of attacks of severe pain only in the facial part of the head, which complicates the diagnosis of the disease, leading the doctor to a diagnosis of atypical facial neuralgia.

In some cases, the pain syndrome is paroxysmal in nature, and the attacks last from several minutes to several hours, in others they constantly torment the patient with mild exacerbations or relief of the condition. Other signs of cervical migraine include nausea, vomiting, a feeling of a “lump in the throat,” dizziness, attention problems, and loss of orientation.

In addition, there is often tinnitus, a feeling of a “stuffed” ear, blurred vision, heaviness on one side of the head, and fatigue. In later stages of the disease, fainting, memory loss, sleep disturbances, irritability and other neurological manifestations are noted.

Symptoms usually increase with movements of the head or body. Hence the fear of moving to a vertical position, fast walking, moving in public transport, the desire to lie down, cover your head with a blanket and not move, which is inherent in patients with Barre-Lieu syndrome. Often the causes of the development of the disease are professional characteristics of work, when the head has to be kept in a static position for a long time. For example, when working at a monitor, with a microscope, on a production line, etc.

Diagnosis and treatment of cervical migraine

Diagnosis of the disease begins with collecting anamnesis, the patient’s description of disturbing symptoms, the nature and location of the pain syndrome. Then a series of radiographic images are taken in different projections to determine the location of the pathology, if it is associated with vertebrogenic causes.

Anomalies in the structure or location of blood vessels are better reflected by magnetic resonance or computed tomography of the spinal column with its surrounding structures. To determine the patency of blood vessels, duplex Doppler sonography is used. A brain scan will help visualize circulatory problems, if any.

Treatment of the disease depends on the causes of the attack of pain. This is usually bed rest during the acute period, and it is advisable to place the patient on a hard mattress on his back, with or without a low pillow. A dry, warm compress on the neck will help relieve the pain, which will improve blood circulation and relieve swelling of the soft tissues. Analgesic painkillers or local novocaine blockades will help relieve acute pain.

After the acute period has passed, the patient is prescribed physiotherapy (electrophoresis, magnetic therapy, phonophoresis, etc.), manual therapy (acupuncture, reflexology and relaxation therapy, etc.), massages, exercise therapy, and, if necessary, spinal traction. Medicines that can be used are non-steroidal anti-inflammatory drugs, muscle relaxants, vitamin complexes, antidepressants, drugs that improve blood circulation throughout the body (actovegin) and in the brain (for example, ginkgo biloba).

Next, annual spa treatment or relapse prevention is indicated, including taking medicinal baths or mud, massage courses, constant monitoring by the attending physician, as well as eliminating factors that may provoke a deterioration in the patient’s health.

Surgical treatment is indicated only in particularly severe cases, when the issue of the patient’s life is being resolved.
This usually happens when the cervical vertebrae are injured or unstable and require the installation of a stabilizing system. Author: K.M.N., Academician of the Russian Academy of Medical Sciences M.A. Bobyr

Prevention

Most often, people suffering from migraines take medications to relieve pain
. This, of course, does not cure migraines, but it significantly improves the quality of life.

There are cases when migraine pain does not respond to painkillers. Then it is better to aim at preventing the development of a headache attack, i.e. prevention

. With its help, you can alleviate attacks of pain or completely eliminate them.

The first and simplest thing you can do is to identify the irritant and try to avoid it. The set of preventive measures includes:

• meditation;
• cold and hot shower;
• physical exercise;
• adhere to a sleep schedule;
• shoulder and neck massage;
• take vitamin B2, magnesium, fish oil and ginger;
• try to remain calm and less nervous;
• proper nutrition and diet (limit foods rich in tyramine).

There are also several proven folk methods for relieving migraine pain.

1. Drink a herbal infusion (chamomile + willow root + raspberry leaves + lavender + peppermint).
2. Oregano infusion (drink a glass 3 times a day).
3. Mumiyo solution (drink before bed for 14 days).
4. Cold compresses (or apply a cabbage leaf) and a contrast shower.

A distracting stimulus
may also help . This could be a piece of lemon peel without zest on the sore side of the temple or mustard plasters on the calves.

Diagnostics

To diagnose the disease, it is necessary not only to collect an anamnesis, but also to conduct research aimed at detecting disorders in the cervical spine. The main diagnostic measures are:

• X-ray of the neck - it allows you to determine the presence of serious changes in the condition of the cervical vertebrae and assess their degree;
• REG is an examination that characterizes the degree of cerebral circulation, which is important for determining the level of disturbance in the vertebral arteries;
• MRI or CT (depending on the equipment of the medical institution) is a fairly expensive but accurate method for determining disorders. It makes it possible to assess the condition of each vertebra and intervertebral disc, as well as the canals in which the vessels and arteries pass.

After obtaining complete data on the patient’s condition, therapy is carried out aimed at eliminating the cause of narrowing of the arteries. Cervical migraine, the symptoms and treatment of which are determined by the doctor after examination, is eliminated quite effectively if the condition is not neglected.