An 81-year-old male patient using continuous positive airway pressure therapy for obstructive sleep apnoea developed right-sided cervicalgia and hemicranial headache triggered by mechanical nerve compression from his mask headgear, according to a case report published in cureus.com.
The patient presented to a Physical Medicine and Rehabilitation clinic with a one-year history of pain and limited cervical rotation, as cureus.com reported. Medical imaging previously revealed multilevel cervical degenerative disc-osteophyte disease with severe foraminal stenosis, leading clinicians to initially attribute the symptoms to cervical spondylosis.
Uncovering the Precise Temporal Relationship
Further clinical history review uncovered a precise temporal relationship between the onset of the patient’s symptoms and his initiation of nocturnal continuous positive airway pressure therapy. The multi-point headgear used to secure the full-face mask exerts sustained circumferential tension around the occiput and mastoid region. This tension anatomically overlaps the course of the lesser occipital nerve, a cutaneous branch of the cervical plexus that ascends along the posterior border of the sternocleidomastoid muscle.
The patient exhibited hyperalgesia sharply confined to the territory of the lesser occipital nerve, and his pain was actively reproduced by cervical rotation. These clinical signs pointed away from the presumed spondylotic cause and toward mechanical entrapment of the nerve by the device straps.
Targeted Intervention Overcomes Initial Treatments
Initial treatments directed at the presumed spondylotic and myofascial aetiology—including pregabalin, physiotherapy, and mesotherapy—yielded limited clinical benefit for the patient. To confirm the new diagnosis, clinicians performed an ultrasound-guided anaesthetic block of the right lesser occipital nerve under aseptic technique.
Definite Relief Confirms Strap-Related Compression
The procedure resulted in immediate and complete resolution of the patient’s pain on cervical rotation. The intervention confirmed that repetitive strap-related compression and traction along the nerve’s anatomical course caused the lesser occipital neuralgia, even in the presence of confounding degenerative cervical spine disease.
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