ISSN: 2578-4838
Dopplerographic Evaluation of Blood Flow Parameters in Vertebral Arteries in Patients with Cervicogenic Headache in the Presence of Uncovertebral Arthrosis
Authors:
Abdullaiev RY*, Kalashnikov VI, Posokhov NF and Kostyukovskaya AE
Introduction: Cervicogenic headache (CH) - one of the most common, is due to biomechanical dysfunction of the cervical vertebral motor segments. It accounts for 15-20% of all headaches. According to International Classification of Headache-Related Disorders (ICHRD-3 beta, 2013) CH is a headache caused by a lesion of the neck (bone structures, disc and / or soft tissues) and is usually accompanied by pain in the neck. The unilateral character of the headache without changing sides, the provocation of a typical image of pain by external pressure on the muscles of the neck or movement of the cervical spine, the spread of pain from the occipital region to frontotemporal, are most characteristic of CH.
Objective: Dopplerographic evaluation of blood flow parameters in vertebral arteries in patients with cervicogenic headache, diagnosed with arthrosis of the uncover vertebral and atlanto-axial articulations.
Materials and methods: A retrospective analysis of the results of Doppler ultrasound in the 2nd and 3rd segments of the vertebral artery (VA) was performed in 43 patients aged 23-39 years, who had X-ray and MRI diagnosed arthrosis of the uncovertebral junction at the level of C2-C3 to C4-C5; among them the instability of one of the upper cervical vertebrae was noted in 21 cases. Among the examined were 26 men and 17 women. The maximum systolic velocity (Vs), the end diastolic velocity (Vd), the resistance index (RI) in second and third segments of VA in the neutral spine and flexion position of the neck were determined. The control group consisted of 24 people aged 18-35 years without chronic headache, absence of arthrosis of the uncovertebral joints according to the results of X-ray or MRI. Dopplerography was conducted on a Philips HD 11XE device using a linear and micro convection transducers in the frequency range 5-10MHz and 4-9 MHz; MRI - General Electric, Signa HDI, 1.5T
Results: In patients with uncovertebral arthrosis at the level of C5-C6, Vs and RI did not differ from the norm and amounted to 53.7±6.1 cm/s, RI – 0.59±0.03; at the level of C2-С3 – 42.9±5.3 cm/s, RI – 0.62±0.03. When the head turned to the side at the C2-C3 level, a significant (P <0.05) decrease in Vs was observed up to 34.7±5.9 cm/s and an increase in RI to 0.69±0.04. In patients with uncovertebral arthrosis in combination with instability of the upper cervical vertebrae at the level of C5-C6, Vs and RI amounted to 51.4±5.8 cm/s, RI – 0.58±0.03; at the level of C2-С3 – 38.5±5.7 cm/s, RI – 0.62±0.03. When the head turned to the side at the C2-C3 level, a significant (P <0.01) decrease in Vs was observed up to 27.6±4.8 cm/s and an increase in RI to 0.71±0.04. When the head was turned to the side in patients with instability of the upper cervical vertebrae and unkorvertebral arthrosis, Vs was significantly lower compared to the control group (27.6±4.8 cm/s and 42.6±4.7 cm/s; P<0.05).
Conclusion: Uncovertebral arthrosis in combination with the instability of the upper cervical vertebrae is one of the common causes of cervicogenic headache. The main pathogenetic mechanism is changes in blood flow at the border of the second and third segments of the vertebral arteries, especially after rotational movements.
Keywords:
Cervicogenic Headache; Dopplerography; Vertebral Artery; Uncovertebral Arthrosis; Instability of the Upper Cervical Vertebrae
