![]() ![]() His headache, however, was continuously non-throbbing with a radiating pattern without morning exacerbation. However, his headache did not subside.Īt first, it was suspected that the cause of headache was an intracranial mass, but there was no sign of increased intracranial pressure. Four months before referral to us, a gamma-knife surgery was performed successfully for suspicious metastatic brain lesions in the left frontal lobe and bilateral cerebellar hemisphere, which were found on MRI. On medical history, he had received one percutaneous ethanol injection and nine transarterial chemo embolizations for hepatocelluar carcinomas caused by hepatitis B virus infection. His pain was located in the left auriculotemporal area, and its intensity was 8 out of 10 on the 10 cm-visual analogue scale (VAS). Herein, we report the management of headache derived from hidden metastasis to a cervical lymph node adjacent to the superficial cervical plexus under ultrasonographic guidance.Ī 65-year-old male was referred to our pain center for management of a severe headache lasting 4 months. Although a superficial cervical plexus block can be performed using a blind technique, ultrasonographic scanning is thought to be essential before needle insertion, especially in patients with medical history of cancer. In cases where the superficial cervical plexus is suspected of causing headache on history and physical examinations, a diagnostic block can be performed between the sternocleidomastoid muscle and the levator scapulae muscle. However, the superficial cervical plexus can also cause localized neuropathic pain around the ear via the lesser occipital nerve and auricular nerves. Most cervicogenic headaches are derived from the cervical facet joint, posterior neck muscles, greater or third occipital nerve. Even though most headaches have a benign course, it is important to differentiate primary from secondary headache because the latter might be caused by neoplasm.Ĭervicogenic headache is a secondary form of headache mainly characterized by pain unilaterally referred to the fronto-temporal or possibly the supraorbital area. When you go see a doctor, they'll be able to determine the underlying cause.Confronting patients with headache, it is often difficult to determine its etiology. ![]() Unlike a viral infection, a bacterial infection often requires medical treatment via a prescribed antibiotic for the infection to go away.
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