Referred pain after painful stimulation of the greater occipital nerve in humans: evidence of convergence of cervical afferences on trigeminal nuclei

Authors

  • Ej Piovesan,

    1. Setor de Cefaléias, Especialidade de Neurologia, Departamento de Clı´nica Médica do Hospital de Clı´nicas da Universidade Federal do Paraná, Curitiba, Paraná, Brazil
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  • Pa Kowacs,

    1. Setor de Cefaléias, Especialidade de Neurologia, Departamento de Clı´nica Médica do Hospital de Clı´nicas da Universidade Federal do Paraná, Curitiba, Paraná, Brazil
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  • Ce Tatsui,

    1. Setor de Cefaléias, Especialidade de Neurologia, Departamento de Clı´nica Médica do Hospital de Clı´nicas da Universidade Federal do Paraná, Curitiba, Paraná, Brazil
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  • Mc Lange,

    1. Setor de Cefaléias, Especialidade de Neurologia, Departamento de Clı´nica Médica do Hospital de Clı´nicas da Universidade Federal do Paraná, Curitiba, Paraná, Brazil
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  • Lc Ribas,

    1. Setor de Cefaléias, Especialidade de Neurologia, Departamento de Clı´nica Médica do Hospital de Clı´nicas da Universidade Federal do Paraná, Curitiba, Paraná, Brazil
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  • Lc Werneck

    1. Setor de Cefaléias, Especialidade de Neurologia, Departamento de Clı´nica Médica do Hospital de Clı´nicas da Universidade Federal do Paraná, Curitiba, Paraná, Brazil
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Elcio Juliato Piovesan, Serviço de Neurologia, Hospital de Clı´nicas da UFPR, Rua General Carneiro 181, 12 (0) andar, Sala 1236 – ZIP 80060–900, Curitiba, Paraná, Brazil, e-mail piovesan@avalon.sul.com.br Received 28 October 1999, accepted 19 January 2001

Abstract

Cranial sensory innervation is supplied mainly by the trigeminal nerves and by the first cervical nerves. Excitatory and inhibitory interactions among those nerve roots may occur in a mechanism called nociceptive convergence, leading to loss of somato-sensory spatial specificity. Three volunteers in an experimental trial had sterile water injected over their greater occipital nerve on one side of the neck. Pain intensity was evaluated 10, 30 and 120 s after the injection. Two of the patients reported intense pain. Trigeminal autonomic features, suggestive of parasympathetic activation, were seen associated with trigeminally distributed pain. These data add to and reinforce previous evidence of convergence of cervical afferents on the trigeminal sensory circuit.

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