A case of cervicogenic headache caused by C5 nerve root derived shwannoma: Case report

Abstract

Introduction We report a case of cervicogenic headache caused by an intradural extramedullary tumor of the middle cervical spine, which has not previously been reported. Case presentation The patient was a 73-year-old male who visited a physician for a chief complaint of pain from the left lower jaw to the auricle and occipital region. The headache was induced with retroflexion of the neck. On cervical magnetic resonance imaging, an intradural extramedullary tumor was noted on the left side at the C4/5 level. The intradural tumor, which arose from the C5 nerve root, was excised and the pain was resolved. The pathological diagnosis was schwannoma. Conclusion Previously reported cases of spinal cord tumor-induced cervicogenic headache were due to upper cervical spinal tumors. This is the first report that a middle-lower cervical intradural extramedullary tumor caused cervicogenic headache.

The Clinical Features, Risk Factors, and Surgical Treatment of Cervicogenic Headache in Patients With Cervical Spine Disorders Requiring Surgery

“…These findings suggest that lesions below C4 can be responsible for CEH in some patients. In agreement with this finding, several case reports and small case series have reported headache relief following surgical treatment of middle‐lower cervical spine disorders …”

“…We can propose several possibilities; first, while most pain stimulation entering through the nerve root passes through the dorsal horn of the spinal cord and ascends via the contralateral anterior spinothalamic tract, some nociceptive input ascends via the ipsilateral spinocervicothalamic tract . It is possible that the spinocervicothalamic tract and trigeminospinal complex communicate through anastomosis . Another possible mechanism is that excessive increases in ROM of the upper cervical spine occurring to compensate for kinesthetic impairment in the lower cervical spine cause overstimulation of the trigeminocervical nucleus, thereby triggering a CEH.…”

“…In agreement with this finding, several case reports and small case series have reported headache relief following surgical treatment of middle-lower cervical spine disorders. [7][8][9]18,19 Given that there is no known neuroanatomical link between middle-lower cervical afferents and the trigeminocervical nucleus, 6 the mechanism by which lower cervical spine disorders cause headache remains unknown. [7][8][9] We can propose several possibilities; first, while most pain stimulation entering through the nerve root passes through the dorsal horn of the spinal cord and ascends via the contralateral anterior spinothalamic tract, some nociceptive input ascends via the ipsilateral spinocervicothalamic tract.…”

“…20 It is possible that the spinocervicothalamic tract and trigeminospinal complex communicate through anastomosis. 18,19 Another possible mechanism is that excessive increases in ROM of the upper cervical spine occurring to compensate for kinesthetic impairment in the lower cervical spine cause overstimulation of the trigeminocervical nucleus, 21 thereby triggering a CEH. Future research is required to determine the validity of these hypotheses.…”

Headache Relief Is Maintained 7 Years After Anterior Cervical Spine Surgery: Post Hoc Analysis From a Multicenter Randomized Clinical Trial and Cervicogenic Headache Hypothesis

“…18 Despite this theory, CGH has been clinically noted in patients with lower cervical spine pathology as well. 19,20 While the trigeminocervical convergence theory explains the origin of CGH from the upper cervical spine, it does not provide a direct neuroanatomic basis for the causation of CGH from the lower cervical spine. Several hypotheses have been proposed by investigators to explain CGH etiology from the lower cervical spine.…”