Atypical neuralgias of the head: Headaches, so-called migraine and complications of whiplash injuries and other cervical trauma

Abstract

Relief of atypical neuralgias of the head and face, occipital neuralgia and migrainous headache may be secured by painstaking and accurate injection of 2 per cent procaine into the sensitized trigger points, repeating the injections if necessary until all trigger spots have been abolished. The sensitized trigger points are caused by trauma, toxins or compression of the small unmyelinated sympathetic fibers in and accompanying blood vessels, and in the subcutaneous tissues, muscles, fascia, ligaments and attachments of muscles to bone. The usual location of these trigger points for the various types of neuralgias of the head and neck has been described and illustrated. Sensitized areas from strains or sprains, such as occur in whiplash injuries, involve the deeper posterior rotator neck muscles, and trigger points are found in the interspinous ligament and its bursae, between the spines of the cervical vertebrae and the strained attachments of muscles to the transverse processes of these vertebrae. From these locations may originate the referred pain to the occipital and frontal parts of the head, face, shoulders and even down the back. To prevent recurrence of the neuralgia after injections of the trigger points, especially in patients depleted from long-continued pain causing repeated mild alarm reactions, vitamins and adrenal cortex and/or anterior pituitary preparations in particular are given. Recently the use of the Rauwolfia root or its alkaloid, reserpine, for suppression of the sympathetic predominance at the hypothalamic level has served better than anterior pituitary substances in relieving headache, crying or the profuse perspiration that some patients experience.