Abstract
Aim: To investigate the incidence of headache and facial pain in patients with neck pain and/or brachalgia and determine any potentially causal relationship.
Methods & Results: Sequential patients referred to the spinal clinic for assessment of their cervical spine were asked to shade on pain drawings, the distribution of pain and sensory disturbance which they were experiencing.
The distribution of shading was categorised as head pain (subdivided into face, vertex and occiput) and arm pain. The incidence of head pain and its distribution was analysed along with its relationship to arm pain.
Data collected from patients presenting with thoracolumbar pain over the same period was used as a control.
Of 200 patients presenting to the clinic with cervical problems, 58 had head pain. 50 had occipital pain, 28 had vertex pain and 8 had facial pain. None of the thoracolumbar patients had head pain although 12 had upper limb pain.
Of the 26 cervical patients who had unilateral arm pain & head pain, the head and arm pain were always on the same side.
Conclusion: Head & facial pain in association with neck pain and brachalgia is common. The homolaterality of symptoms suggest the potential for causal relationships hitherto unrecognised in the literature. It is possible that some patients given medical diagnoses for their headache (e.g. migraine) might have surgically treatable cervical pathology. Clearly, further investigation to elucidate this potential relationship is required.
Correspondence should be addressed to BASS/BCSS c/o BOA, at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London, WC2A 3PE, England.
