gms | German Medical Science

60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit den Benelux-Ländern und Bulgarien

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

24. - 27.05.2009, Münster

Chronic cluster headache remitting after cervical spondylodesis: case report

Meeting Abstract

  • T. Wolter - Interdisziplinäres Schmerzzentrum, Albert-Ludwigs-Universität Freiburg
  • S. Knoeller - Interdisziplinäres Schmerzzentrum, Albert-Ludwigs-Universität Freiburg
  • K. Kieselbach - Interdisziplinäres Schmerzzentrum, Albert-Ludwigs-Universität Freiburg
  • H. Kaube - Interdisziplinäres Schmerzzentrum, Albert-Ludwigs-Universität Freiburg

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocP15-09

DOI: 10.3205/09dgnc418, URN: urn:nbn:de:0183-09dgnc4180

Veröffentlicht: 20. Mai 2009

© 2009 Wolter et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: Chronic cluster headache belongs to the most disabling vasomotor pain conditions. Treatment usually implies medical treatment and oxygen application in case of acute pain attacks. Among the known triggers for cluster periods are orbital exenteration, head injury, dental extraction, impacted superior wisdom tooth as well as cervical pain due to cervical nerve root compression.

Methods: We describe the case of a 65-year-old patient who had suffered from severe headache which had begun after a head injury with a protracted wound infection at the age of 9 years. The pain began in the nape of his neck and irradiated behind his eye and into the cheek.

Cervical fusion in 1984 (C 5/6 and C 6/7 with iliac crest bone graft) and 1986 (C 5-7 with ventral plate osteosynthesis) as well as bilateral transsection of the occipital nerve in 1990 had no influence on this pain. In 2004 the diagnosis of cluster headache was made and medical and oxygen treatment was commenced. In May 2008 progressive right sided neck pain occurred. The pain irradiated over the head and led to almost daily cluster attacks.

X-ray of the cervical spine in flexion/extension showed osseous consolidation C5-C7 but a noticeable spondylolisthesis C4/C5. The patient then wore a diagnostic cervical cast for one week leading to complete relief of neck pain, headache and cluster attacks. With the diagnosis of instability now ventral spondylodesis C4/C5 was performed.

Results: After an uneventful perioperative course in July 2008 pain was relieved to a large extent from the first postoperative day on. During the one week postoperative stay there were no further cluster attacks. Six weeks after the operation the patient reported that his cluster headache had decreased by 80%. Pain intensity had declined as well as the usual duration of the attack.

Conclusions: In rare cases cervical instability can trigger cluster headache. The operative correction of instability in these cases might lead to a decrease in attack frequency and intensity.