Unremitting head and neck pain (UHNP) is a commonly encountered phenomenon in Headache Medicine and may be seen in the setting of many well-defined headache types. The prevalence of UHNP is not clear, and establishing the presence of UHNP may require careful questioning at repeated patient visits. The cause of UHNP in some patients may be compression of the lesser and greater occipital nerves by the posterior cervical muscles and their fascial attachments at the occipital ridge with subsequent local perineural inflammation. The resulting pain is typically in the sub-occipital and occipital location, and, via anatomic connections between extracranial and intracranial nerves, may radiate frontally to trigeminal-innervated areas of the head. Migraine-like features of photophobia and nausea may occur with frontal radiation. Occipital allodynia is common, as is spasm of the cervical muscles. Patients with UHNP may comprise a subgroup of Chronic Migraine, as well as of Chronic Tension-Type Headache, New Daily Persistent Headache and Cervicogenic Headache. Centrally acting membrane-stabilizing agents, which are often ineffective for CM, are similarly generally ineffective for UHNP. Extracranially-directed treatments such as occipital nerve blocks, cervical trigger point injections, botulinum toxin and monoclonal antibodies directed at calcitonin gene related peptide, which act primarily in the periphery, may provide more substantial relief for UHNP; additionally, decompression of the occipital nerves from muscular and fascial compression is effective for some patients, and may result in enduring pain relief. Further study is needed to determine the prevalence of UHNP, and to understand the role of occipital nerve compression in UHNP and of occipital nerve decompression surgery in chronic head and neck pain.

中文翻译：

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持续性头颈部疼痛中枕神经受压的新证据

持续性头颈痛 (UHNP) 是头痛医学中常见的现象，可以在许多明确定义的头痛类型的情况下看到。UHNP 的患病率尚不清楚，确定 UHNP 的存在可能需要在患者反复就诊时仔细询问。部分患者发生 UHNP 的原因可能是颈后肌及其在枕骨嵴处的筋膜附件压迫小枕神经和大枕神经，随后导致局部神经周围炎症。由此产生的疼痛通常发生在枕下和枕骨位置，并且通过颅外和颅内神经之间的解剖连接，可能会从正面放射到头部的三叉神经支配区域。额叶辐射可能会出现畏光和恶心的偏头痛样特征。枕部异常性疼痛很常见，颈部肌肉痉挛也很常见。患有 UHNP 的患者可能包括慢性偏头痛以及慢性紧张型头痛、新的日常持续性头痛和颈源性头痛亚组。中枢作用的膜稳定剂通常对 CM 无效，但同样对 UHNP 无效。颅外治疗，如枕神经阻滞、颈椎激痛点注射、肉毒杆菌毒素和针对降钙素基因相关肽的单克隆抗体，主要作用于外周，可能为 UHNP 提供更实质性的缓解；此外，肌肉和筋膜压迫对枕神经的减压对某些患者有效，并可能导致持久的疼痛缓解。需要进一步研究来确定 UHNP 的患病率，