Craniocevricalgia

Сraniocervicalgia is a collective clinical term that unites pain syndromes localized in the occipital and cervical area, which can spread to the frontal, temporal and orofacial areas. Clinically, the most common types of сraniocervicalgia are cervicogenic headache (CH), neck pain caused the temporomandibular joint dysfunction and craniocervicalgia caused of the vertebral arteries dissection. Diagnosis of craniocervicalgia should be based on the diagnostic criteria of the International Classification of Headache Disorders, 3rd revision (2018) with an analysis of the individual pain features. The characteristic of the CH is defined in the name itself. The most significant point is dysfunction of the three upper cervical segments. Pathological changes in the anatomical structures of the spinal column (facet joints, annulus fibrosus, ligaments, periosteum), muscles and tendons innervated by the upper cervical segments may be the source of CH. The convergence of the upper cervical sensory nerves (C1-C3) and trigeminal nerve fibers in spinal trigeminal nucleus at the upper cervical segments is believed to be more important for the development of CH. Usually, it`s a dull, aching, unilateral pain, which is provoked by a prolonged forced head position (uncomfortable posture) and movements in the cervical spine (turns, tilts of the head). Cervical movement restrictions in one or more directions is noted. In general, the diagnosis is mainly based on clinical examination, but can be confirmed by a diagnostic blockade of the cervical facet joints, after which patients can get partial or complete pain relief. We present a clinical case with a typical progress of CH. The patient was recommended daily 15–30 minute exercise therapy, hourly a few exercises for activation and stabilization of the cervical spine muscles, and increase general physical activity. Symptomatic treatment with a non-steroidal anti-inflammatory drug was prescribed – Nurofen Express Forte, containing 400 mg of ibuprofen in a capsule with liquid contents, twice a day for 2 weeks. During a follow-up examination after 15 days, the patient reported a pain relief at rest, the maximum pain intensity according to the visual analog scale decreased from 5 to 1 mm during movement. The patient’s general well-being and tolerance to prolonged postural tension significantly improved. Further recommendations included a training program for spine stabilization the and muscles endurance. After 3 months of patient observation, a therapeutic stability was noted. Considering the high antinociceptive efficacy of Ibuprofen, use of Nurofen Express Forte should be recommended in the complex treatment of patients with CH.