Purpose. The anatomical mechanisms of cervicogenic headache caused by upper cervical lesions have been reported. However, the pathomechanisms of headache caused by lower cervical spine disorders remain unknown. The purpose of the current study was to clarify the prevalence and pathogenesis of headaches in patients with cervical spondylotic myelopathy (CSM). Methods. In this retrospective study, a questionnaire regarding preoperative and postoperative symptoms was sent to 147 patients with CSM who were surgically treated in our hospital during the previous 10 years. All of the surgical procedures were decompression surgeries between the C3 and C7 levels. Data from 74 patients (50.3%) were available for analysis. Subjects were divided into four groups according to the presence or absence of preoperative and postoperative headache. The severity of pain, severity of neuropathic pain symptoms, depression, severity of myelopathy, and quality of life (QOL) were also evaluated using questionnaires. The scores of these questionnaires were then compared between the four groups. Kruskal–Wallis tests with Dunn–Bonferroni post hoc tests were used for comparisons. Results. Of the patients with CSM, 31% had headaches preoperatively, and 43% of these headaches disappeared postoperatively. Type 4 (preoperative headache-positive/postoperative headache-positive) patients had more severe pain and neuropathic pain symptoms and lower QOL scores compared with type 1 (preoperative headache-negative/postoperative headache-negative) patients. Conclusions. Approximately one-third of all patients with CSM had headaches preoperatively. Headache in patients with CSM may be neuropathic pain. A proportion of headaches in patients with CSM can be treated by decompression surgery.

中文翻译：

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颈椎病脊髓病患者的头痛

目的。上颈椎病变引起的宫颈源性头痛的解剖机制已有报道。然而，由下颈椎疾病引起的头痛的发病机制仍然未知。本研究的目的是阐明颈椎病性脊髓病（CSM）患者的头痛患病率和发病机理。方法。在这项回顾性研究中，我们向前10年在我院接受手术治疗的147例CSM患者发送了有关术前和术后症状的问卷。所有的外科手术都是在C3和C7水平之间进行减压手术。74位患者（50.3％）的数据可用于分析。根据术前和术后头痛的存在与否，将受试者分为四组。还使用问卷调查评估了疼痛的严重程度，神经性疼痛症状的严重程度，抑郁症，脊髓病的严重程度和生活质量（QOL）。然后将这些问卷的得分在四组之间进行比较。Kruskal-Wallis检验与Dunn-Bonferroni事后检验用于比较。结果。在CSM患者中，有31％的患者术前头痛，其中43％的头痛在术后消失。与1型（术前头痛阴性/术后头痛阴性）患者相比，4型（术前头痛阳性/术后头痛阳性）患者具有更严重的疼痛和神经性疼痛症状，且QOL得分更低。结论。约有三分之一的CSM患者术前头痛。CSM患者的头痛可能是神经性疼痛。减压手术可以治疗一部分CSM患者的头痛。