Brain, Vol. 125, No. 7, 1496-1509,
July 2002
© 2002 Guarantors of Brain
Stimulation of the greater occipital nerve induces increased central excitability of dural afferent input
1 Headache Group, Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
Correspondence to: P. J. Goadsby, Institute of Neurology, Queen Square, London WC1N 3BG, UK E-mail: peterg{at}ion.ucl.ac.uk
Patients with primary headaches often report pain that involves not only the front of the head, innervated by the first (ophthalmic) division of the trigeminal nerve, but also the back of the head, innervated by the greater occipital nerve (GON) that is a branch of the C2 spinal root. The aim of this work was to study the physiology of trigeminocervical input in a model of cranial nociception by describing a population of nociceptive neurones that receive convergent input from the supratentorial dura and the GON. Rats were anaesthetized with pentobarbital, paralysed and ventilated. The parietal dura above the middle meningeal artery was stimulated through a closed cranial window. The GON was exposed in the neck and stimulated. Recordings were made from 67 neurones (52 wide dynamic range neurones/15 nociceptive-specific-neurones) in the C2 spinal dorsal horn, which responded to stimulation of the dura and the GON. Most neurones showed receptive fields corresponding to the first trigeminal division as well as input from C2 skin and muscle. Neurones were recorded in superficial and deep layers of the dorsal horn. All neurones tested received input from the ipsilateral and contralateral GON (n = 5). The responses to dural stimulation were analysed before and after stimulation of the GON. Supramaximal electrical stimulation of the GON (20 s to 5 min) enhanced afferent dural input in 8/20 neurones. Application of the C-fibre activator mustard oil (MO) to the cutaneous receptive field or suboccipital muscles innervated by the GON induced an increased excitability of dural responses in 8/12 and 9/10 neurones, respectively. Stimulation of muscle afferents had a significant longer facilitatory effect than cutaneous stimulation (P < 0.05). These results show that a considerable population of neurones show convergent input from both dura as well as cervical cutaneous and muscle territories, which supports the view of a functional continuum between the caudal trigeminal nucleus and upper cervical segments involved in cranial nociception. The facilitatory effect of GON stimulation on dural stimulation suggests a central mechanism at the second order neurone level. This mechanism may be important in pain referral from cervical structures to the head and therefore have implications for most forms of primary headache.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  M-S Yoon, D Mueller, N Hansen, F Poitz, M Slomke, P Dommes, H. Diener, Z Katsarava, and M Obermann Prevalence of Facial Pain in Migraine: A Population-Based Study Cephalalgia, January 1, 2010; 30(1): 92 - 96. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T Wolter, H Kaube, and M Mohadjer High Cervical Epidural Neurostimulation for Cluster Headache: Case Report and Review of The Literature Cephalalgia, October 1, 2008; 28(10): 1091 - 1094. [Full Text] [PDF]
|
|
|
|
|
|
P. Goadsby and T Bartsch Introduction: On the Functional Neuroanatomy of Neck Pain Cephalalgia, July 1, 2008; 28(1_suppl): 1 - 7. [Full Text] [PDF]
|
|
|
|
|
|
B. Robertson and M. Morris The Role of Cervical Dysfunction in Migraine: A Systematic Review Cephalalgia, May 1, 2008; 28(5): 474 - 483. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A Ashkenazi, R Matro, J W Shaw, M A Abbas, and S D Silberstein Greater occipital nerve block using local anaesthetics alone or with triamcinolone for transformed migraine: a randomised comparative study J. Neurol. Neurosurg. Psychiatry, April 1, 2008; 79(4): 415 - 417. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Jurgens, V Busch, T Schmidt-Wilcke, G Schuierer, E Leinisch, and A May Migraine-Like Headache in Intracranial Haemorrhage is Alleviated by Sumatriptan and Almotriptan Cephalalgia, March 1, 2008; 28(3): 302 - 304. [Full Text] [PDF]
|
|
|
|
|
|
V Busch, W Jakob, T Juergens, W Schulte-Mattler, H Kaube, and A May Occipital Nerve Blockade in Chronic Cluster Headache Patients and Functional Connectivity Between Trigeminal and Occipital Nerves Cephalalgia, November 1, 2007; 27(11): 1206 - 1214. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M Obermann, D Mueller, M-S Yoon, L Pageler, H. Diener, and Z Katsarava Migraine With Isolated Facial Pain: A Diagnostic Challenge Cephalalgia, November 1, 2007; 27(11): 1278 - 1282. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Shin, H. Song, J. Lee, W. Kim, and M. Chu Paroxysmal Stabbing Headache in The Multiple Dermatomes of The Head and Neck: A Variant of Primary Stabbing Headache or Occipital Neuralgia? Cephalalgia, October 1, 2007; 27(10): 1101 - 1108. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G Bruti, C Mostardini, A Pierallini, V Villani, C Modini, and R Cerbo Neurovascular Headache and Occipital Neuralgia Secondary to Bleeding of Bulbocervical Cavernoma Cephalalgia, September 1, 2007; 27(9): 1074 - 1079. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G Jull, M Amiri, J Bullock-Saxton, R Darnell, and C Lander Cervical Musculoskeletal Impairment in Frequent Intermittent Headache. Part 1: Subjects With Single Headaches Cephalalgia, July 1, 2007; 27(7): 793 - 802. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C Fernandez-de-las-Penas, M. Cuadrado, L Arendt-Nielsen, D. Simons, and J. Pareja Myofascial Trigger Points and Sensitization: An Updated Pain Model for Tension-Type Headache Cephalalgia, May 1, 2007; 27(5): 383 - 393. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Schwedt, D. Dodick, T. Trentman, and R. Zimmerman Response to Occipital Nerve Block is Not Useful in Predicting Efficacy of Occipital Nerve Stimulation Cephalalgia, March 1, 2007; 27(3): 271 - 274. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Schwedt, D. Dodick, J Hentz, T. Trentman, and R. Zimmerman Occipital Nerve Stimulation for Chronic Headache--Long-Term Safety and Efficacy Cephalalgia, February 1, 2007; 27(2): 153 - 157. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Schwedt, D. Dodick, T. Trentman, and R. Zimmerman Occipital Nerve Stimulation for Chronic Cluster Headache and Hemicrania Continua: Pain Relief and Persistence of Autonomic Features Cephalalgia, August 1, 2006; 26(8): 1025 - 1027. [Full Text] [PDF]
|
|
|
|
|
|
P. Schmidt-Hansen, P Svensson, T. Jensen, T Graven-Nielsen, and F. Bach Patterns of Experimentally Induced Pain in Pericranial Muscles Cephalalgia, May 1, 2006; 26(5): 568 - 577. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M Volcy, S. Tepper, A. Rapoport, F. Sheftell, and M. Bigal Botulinum Toxin A for the Treatment of Greater Occipital Neuralgia and Trigeminal Neuralgia: A Case Report with Pathophysiological Considerations Cephalalgia, March 1, 2006; 26(3): 336 - 340. [Full Text] [PDF]
|
|
|
|
|
|
V Busch, W Jakob, T Juergens, W Schulte-Mattler, H Kaube, and A May Functional Connectivity between Trigeminal and Occipital Nerves Revealed by Occipital Nerve Blockade and Nociceptive Blink Reflexes Cephalalgia, January 1, 2006; 26(1): 50 - 55. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A Frese, M Schilgen, L Edvinsson, E Frandsen, and S Evers Calcitonin Gene-Related Peptide in Cervicogenic Headache Cephalalgia, September 1, 2005; 25(9): 700 - 703. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E Leinisch-Dahlke, T Jurgens, U Bogdahn, W Jakob, and A May Greater Occipital Nerve Block is Ineffective in Chronic Tension Type Headache Cephalalgia, September 1, 2005; 25(9): 704 - 708. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Barbanti, G. Fabbrini, C. Pauletti, G. Defazio, G. Cruccu, and A. Berardelli Headache in cranial and cervical dystonia Neurology, April 12, 2005; 64(7): 1308 - 1309. [Full Text] [PDF]
|
|
|
|
|
|
L. Stovner, F Kolstad, and G Helde Radiofrequency Denervation of Facet Joints C2-C6 in Cervicogenic Headache: A Randomized, Double-Blind, Sham-Controlled Study Cephalalgia, October 1, 2004; 24(10): 821 - 830. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Bartsch and P. J. Goadsby Increased responses in trigeminocervical nociceptive neurons to cervical input after stimulation of the dura mater Brain, August 1, 2003; 126(8): 1801 - 1813. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Piovesan, B. Young, L. Werneck, P. Kowacs, M. Oshinsky, and S. Silberstein Recurrent Extratrigeminal Stabbing and Burning Sensation with Allodynia in A Migraine Patient Cephalalgia, April 1, 2003; 23(3): 231 - 234. [Full Text] [PDF]
|
|