INTRODUCTION On the functional neuroanatomy of neck pain

摘要

Patients with primary headache often report pain that involves the front of the head/in the cutaneous distribution of the first (ophthalmic) division of the trigeminal nerve and at the same time or evolving, pain in the occipital and upper cervical region (1). Furthermore, other clinical features such as hyper-sensitivity of the skin of the face or scalp, neck muscle tenderness and hyperalgesia are often reported widely in the head (2, 3). The relatively poor localization of pain in primary headache disorders produces significant diagnostic problems and certainly impacts on the understanding of these disorders. In migraine alone, the extremely common premonitory symptom of neck discomfort or pain (4) leads to endless, and almost invariably useless, therapeutic attention to a structure that is as innocent of pathology as are the eyes innocent of pathology in patients with photophobia. An understanding of the anatomy and physiology of the trigeminal and upper cervical neurones that receive convergent input, the trigeminocervical complex, can render the clinical presentation clearer and the management strategies more effective, and must form an important basis for understanding head pain more broadly. Here we set out what is currently known of the anatomy and physiology of these pivotal structures. We have covered some aspects of these issues previously and here provide an updated view (5)