Cervical migraine is one of the typical manifestations of vertebral artery syndrome, which manifests itself in agonizing, migraine-like pain.
Cervical migraine occurs as a result of impaired blood flow in one or both vertebral arteries (right and left).
Synonyms of the disease are – “vertebral artery syndrome”, “posterior cervical sympathetic syndrome”, which causes confusion in terminology.
In the general understanding of this concept, there is a disorder of blood circulation in the brain area due to a violation of blood flow through one or both of the vertebral arteries.
Circulatory disorders in the vertebral arteries provide up to 30% of the blood flow, their problems do not lead to catastrophic consequences in the form of strokes, but can give subjectively unpleasant sensations with bouts of excruciating headaches combined with disorders of coordination, sight or hearing.
All causes of cervical migraine can be divided into two groups.
- non-vertebrogenic (not associated with vertebral problems),
- vertebral (associated with lesions of the vertebrae).
For non-vertebral causes include:
- atherosclerotic vascular disease,
- congenital anomalies of the arteries,
- congenital anomalies of vascular location,
- whiplash (sharp deflection or tilting of the head back when struck or braking hard in the car),
- spasmodic contraction of the neck muscles
Vertebral causes include spinal problems:
- congenital anomalies of the vertebral structure,
- traumatic vertebral abnormalities,
- osteochondrosis of the first-second cervical vertebra,
- instability of the cervical spine,
- idiopathic (with unexplained cause) problems.
As a result of the impact of all the above reasons, irritation of the nerve trunks and vertebral arteries occurs, which causes a spasm of muscular elements in their wall and a sharp narrowing of the lumen of the arteries – a neck migraine begins.
Spasms can be constant or occur when turning the head, bending or changing the position of the body. This leads to a decrease in blood flow to the head and impaired cerebral circulation, to the occurrence of headache attacks.
The process proceeds in two stages:
- episodic vasoconstriction occurs in the first or reversible stage, which is manifested by bouts of headache and associated symptoms.
- in the second stage, an irreversible narrowing of the vascular wall occurs, gradually increasing. Manifestations at the same time become heavier and occur more often.
The main symptom of cervical migraine are headaches. Wherein:
- constant or paroxysmal pain
- excruciating pain, burning, throbbing, localized in the nape,
- during an attack, the pain may be given to the area of the orbits or the bridge of the nose, the region of the crown, ears or forehead,
- the pain is more often unilateral, the seizures increase with a change in the position of the head and neck,
- head soreness when combing or touching
- head turns are accompanied by itching and burning,
- there may be dizziness, nausea with vomiting, especially when lifting the head up,
- ringing or tinnitus, pulsing to the beat of the heartbeat,
- there may be visual and hearing impairment, a veil or a sight before the eyes, dvonie,
- there may be a feeling of a coma in the throat or a violation of swallowing,
- feeling hot or chills,
- in rare cases, when an artery is pinched, there may be bouts of loss of consciousness during sharp head turns.
The characteristic feature is characterized by a lesion of the arteries – when pressing on the area of the spinous processes or the back of the head, there is a sharp increase in the sensitivity of the skin in the neck.
Diagnosis of cervical migraine is based on the characteristic complaints of patients, an indication of injuries or diseases of the cervical spine, as well as on samples with pressing of the projection of additional vertebral arteries with increased symptoms.
In addition, additional research is needed:
- radiography of the cervical region, which reveals clear changes in the vertebral region and clarifies the causes of the disease,
- Doppler ultrasound with assessment of blood flow in the vertebral arteries,
- rheoencephalography with the definition of cerebral blood flow and the specific artery patency,
- CT or MRI of the neck with a layer-by-layer study of the structure of the vertebrae and the state of the arteries,
- blood test for lipids and cholesterol.
Neurologists are engaged in the treatment and diagnosis of cervical migraine. Conservative treatment methods are applied:
- anti-inflammatory and analgesics (meloxicam, nimesulide, nurofen),
- drugs that improve blood circulation and the patency of the vertebral arteries (instenon, cinnarizine),
- B vitamins to improve brain nutrition,
- neuroprotective drugs to protect nerve cells from hypoxia (Cerebrolysin, Piracetam or Actovegin),
- metabolite drugs (mildronate),
- antispasmodics to eliminate spasm of the arteries and muscles (no-spa, papaverine, mydocalm),
- vegetotonic drugs (phenibut),
- anti-migraine drugs (sumatriptan),
- cervical massage, physiotherapy, acupuncture, electrophoresis.
- osteopathic practices
- in severe cases, the surgical stabilization of the cervical vertebrae, the elimination of bone processes.
In the case of a full and timely start of treatment, the prognosis is favorable, manifestations of cervical migraine can be stopped or significantly alleviated. When running with organic disorders, the prognosis is less favorable, you can only relieve seizures.