The Application Value Of High-frequency Ultrasound In The Diagnosis And Treatment Of Cervicogenic Headache

Part Ⅰ: The value of high frequency ultrasound in the diagnosis of Cervicogenic headache Objective To measure the cross-sectional area of the greater occipital nerve(GON)on the surface of the inferior oblique muscle of the head and the thickness of the deep muscles of the neck: longus capitis(LCAP),posterior rectus major(RCPM),superior oblique(OCS)and inferior oblique(OCI)of the head in patients with cervicogenic headache(CEH)and normal subjects.To evaluate the value of high frequency ultrasound in the diagnosis of CEH.Methods A total of 60 patients with CEH diagnosed in the outpatient department and ward of the Department of Neurology of Baotou Central Hospital from June 2019 to December 2020 were selected as the CEH group,and 60 healthy volunteers were selected as the control group.The cross-sectional area of GON and the thickness of LCAP,RCPM,OCS and OCI on the surface of bilateral inferior oblique muscle under high frequency ultrasound were measured and compared between the two groups.To evaluate the value of high frequency ultrasound in the diagnosis of CEH.Results 1.Compared with the control group,the muscle thickness of LCAP,RCPM and OCS on the left and right sides of the CEH group decreased significantly,and the difference was statistically significant(P < 0.05),The average thickness of OCI decreased,but there was no significant difference(P > 0.05).2.The atrophy of LCAP and RCPM on the headache side of the CEH patients was more obvious.3.There was no significant difference in the cross-sectional area of GON between the left and right sides of the CEH group compared with the control group(P > 0.05).Conclusion 1.High-frequency ultrasound can clearly display GON and the deep cervical muscle,observe the anatomical relationship with the adjacent tissues,and accurately measure its cross-sectional area and thickness.2.In this study,there was no difference in the cross-sectional area of GON on the surface of the bilateral inferior oblique muscle between the CEH group and the control group.3.In this study,there is muscle atrophy in LCAP,RCPM and OCS of CEH patients,and the atrophy of LCAP and RCPM on the headache side is more obvious.The measurement of deep cervical muscle thickness by high frequency ultrasound can be used as a new objective basis for non-invasive diagnosis of CEH.Part Ⅱ: the value of high frequency ultrasound in evaluating the efficacy of Cervicogenic headache rehabilitationObjective To explore the value of high-frequency ultrasound in evaluating the curative effect of CEH by comparing the thickness of deep cervical muscles(LCAP,RCPM,OCS,OCI)and Visual analogue Scale(VAS)before and after different treatment schemes.Methods A prospective study was conducted in which 60 patients(From Part I)with CEH diagnosed in the Department of Neurology of Baotou Central Hospital from June 2019 to December 2020 were divided into three groups: Drug Group,Rehabilitation Group and combination group,the three groups were treated with different methods,and the differences of Left(L),Right(R)ultrasonic index and VAS scores before and after treatment were compared.Results 1.There was significant difference in the thickness of L-LCAP,R-LCAP,L-RCPM and R-RCPM between the three groups before treatment and the control group(P < 0.05),but there was no significant difference in the thickness of L-OCS,R-OCS,L-OCI and R-OCI(P > 0.05).2.After 15 days of treatment,there was no significant difference in muscle thickness between the rehabilitation group,the combination group and the control group(P > 0.05).There was significant difference in the thickness of L-LCAP and R-LCAP between the drug group and the control group(P < 0.05),but there was no significant difference in the muscle thickness between the other groups and the control group(P > 0.05),but it was significantly lower than that in the rehabilitation group and the combined group.3.There was no significant difference in muscle thickness among the four groups after 15 days of treatment in the drug group(P >0.05).There was significant difference in the muscle thickness of bilateral LCAP and RCPM between the rehabilitation group and the combined group after 15 days of treatment(P < 0.05).4.The change of VAS score before and after treatment was positively correlated with the improvement of L-LCAP and R-OCS atrophy.Conclusion 1.Both drug therapy and rehabilitation therapy can improve the headache condition of CEH patients.Drug therapy has a quick effect and can improve the headache symptoms of CEH patients in a short time,compared with drug therapy,rehabilitation therapy is less effective in improving headache symptoms in the short term,but the long-term effect is similar,and the combined therapy is obviously better than the single therapy.2.Drug treatment had no significant effect on the deep cervical muscle atrophy in CEH patients,and rehabilitation treatment could improve the deep cervical muscle atrophy in CEH patients,the change of deep cervical muscle thickness under ultrasound can be used as a new objective basis for non-invasive evaluation of CEH therapy.3.The combination of medication and rehabilitation therapy is superior to the other two groups in improving headache symptoms and deep cervical muscle atrophy in CEH patients,which can provide reliable theoretical basis for the treatment of clinical CEH.4.Patients with CEH may have a “Pain-abnormal posture-muscle imbalance-pain”cycle.