Association Between Vertebrobasilar Insufficiency and Cervicogenic Headache: Hypothetical Approach Towards Etiopathogenesis of Headache
Kaur Aninditya, Rakesh N., Reddy Sujatha S., Thomas Nithin, Nagi Ravleen, Patil Deepa Jatti,
소속 상세정보
( Kaur Aninditya ) - DMD Imaging
( Rakesh N. ) - M.S. Ramaiah University of Applied Sciences Faculty of Dental Sciences Department of Oral Medicine and Radiology
( Reddy Sujatha S. ) - M.S. Ramaiah University of Applied Sciences Department of Oral Medicine and Radiology
( Thomas Nithin ) - Maxillofacial Diagnostics
( Nagi Ravleen ) - Swami Devi Dayal Hospital and Dental College Department of Oral Medicine and Radiology
( Patil Deepa Jatti ) - Sumandeep Vidyapeeth Deemed to be University KM Shah Dental College and Hospital Department of Oral Medicine and Radiology
Abstract
Purpose: Cervicogenic headache (CGH) is pain referred to the head/ face from the structures in vicinity of upper cervical spinal nerves via trigeminocervical pathway. Ponticulus Posticus (PP) and Elongated Styloid Process (ESP) are anatomical structures that cause compression of vasculature present around upper cervical nerve plexus. Recently, computational fluid dynamics (CFD) has shown to play an essential role in identification of these highpressure zones in the brain. The aim of this research is to study the association of ESP and PP in patients with CGH and to develop a hypothesis by CFD to analyse vertebrobasilar insufficiency as a contributing factor in occurrence of CGH.
Methods: Retrospective analysis of 4500 full skull CBCT scans was done for the presence of partial or complete PP and length of Styloid Process (SP). Research was divided into two phases; In first Preliminary Phase, 150 scans that showed the presence of PP and ESP were analysed, and only 134 patients gave consent to fill the questionnaire containing 96 question items pertaining to symptoms associated with CGH. In the second phase, simulation of Vertebral and Carotid Artery was done using Fluent 14.5 Software and by CFD, pressure distribution on arteries was obtained that helped to identify high pressure regions.
Results: Both PP and ESP showed a statistically significant association with CGH (p<0.001). By CFD analysis, both steady and transient phases of simulation showed drop in pressure due to constriction of internal carotid and vertebral artery by ESP and PP respectively and were found to decrease the volume of blood reaching the brain, 0.12 /0.13 mL and 0.06 mL respectively.
Conclusions: Our analysis proves ESP and PP as contributing factors towards CGH. Hence for proper diagnosis and management of headache disorders, clinicians should have adequate knowledge about these anatomical structures and their resulting clinical symptoms.
키워드
Blood flow; Cervicogenic headache; Computational fluid dynamics; Ponticulus posticus; Styloid process; Vertebral artery
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