编者按 由上海交通大学医学院附属第九人民医院麻醉科和AME出版社于2022年3月共同创办的《口腔颌面外科麻醉杂志》（Journal of Oral and Maxillofacial Anesthesia，JOMA）是一本开放获取、经同行评审的国际英文医学期刊，聚焦口腔颌面外科、头颈外科和耳鼻喉外科等相关外科手术中的麻醉问题。JOMA杂志旨在发表探讨上述相关外科麻醉领域的前沿热点问题和现状的文章，包括但不限于气道管理、气管插管、全身麻醉诱导及维持、口腔局部麻醉、口腔舒适化诊疗技术以及麻醉实施期间并发症及紧急情况的处理。作为一本电子期刊，JOMA杂志致力于为相关研究者和临床工作者提供开展学术研讨的平台，以期为麻醉学科注入新观点、新思想。JOMA杂志由邱蔚六院士和张志愿院士担任名誉主编，姜虹教授担任主编，夏明教授担任执行主编。 为相关研究者和临床工作者提供开展学术研讨的平台，为麻醉学科注入新观点、新思想，为国内读者提供更为便利的学术交流模式，JOMA杂志将在AME科研时间平台上定期推出中文版。 今天和大家分享的是“神经阻滞和神经节阻滞在头痛治疗中的应用：叙述性综述”。
作者：Davis C. Thomas1, Deepti Chablani2, Srishti Parekh3, Priyanka Kodaganallur Pitchumani4, Saranya Devatha Mallareddy5, Blessy C. Mathai6
1Center for Temporomandibular Disorders and Orofacial Pain, Department of Diagnostic Sciences, Rutgers School of Dental Medicine, Newark, NJ, USA;
2Department of Oral and Maxillofacial Surgery, Terna Dental College, Navi Mumbai, India;
3Private practice, Mumbai, India;
4Department of Periodontology, The Ohio State University College of Dentistry, Columbus, OH, USA;
5Private practice, Toronto, Canada;
6Private practice, Delaware, USA
译者：裴蓓；审校：夏明
背景和目标：头痛、面部疼痛及其他相关疼痛是全世界普通人群疼痛、发病和生活质量下降的重要原因。药物治疗是许多头痛治疗方案的重要组成部分。然而，各种系统性因素和其他因素可能导致患者无法使用药物。部分患者或许难以接受传统的治疗方法。在特定头痛患者中，周围神经阻滞和神经刺激等方法能够对患者的诊断、预后和生活质量产生明显的积极影响。在这篇文章中，我们回顾了特定群体所采用的神经和神经节阻滞的证据、适应证、临床解剖、标志、技术、风险和不良反应。
方法：本叙述性综述的检索是在2021年11月1日—2022年1月20日期间进行的。检索的数据库包括PubMed、Ovid、Science Direct和疼痛管理的教科书。检索词包括神经阻滞、头痛、疼痛管理、偏头痛、个别疼痛实体、个别神经阻滞和神经节阻滞。本综述检索英语书写的完整文章，且只包括1992—2022年间用英语发表的文章。排除标准包括非英语的文章、1992年以前发表的文章和无法获得全文的文章。
主要内容和发现：这篇文献包含了口面部特有的神经解剖结构及其分布、神经支配、神经阻滞技术、药理学，以及用于治疗头痛疾病的特定神经阻滞的不良反应。
结论：神经阻滞作为一种公认的技术出现在文献中，有助于诊断、确定预后、缓解疼痛和头痛治疗。神经阻滞可以大幅改善受头痛影响的患者的生活质量，并且可以极大地提高诊断的准确性，有助于避免诊断上的困难，并使临床医生能够进行快速的疼痛管理。我们有必要进行深入的回顾性和前瞻性研究，探讨各种类型的神经阻滞与其他传统方式相比在治疗头痛方面的功效。
关键词：头痛；疼痛；神经阻滞；偏头痛；疼痛管理
一、简介
头痛、面部疼痛及相关疼痛是全世界普通人群疼痛、发病和生活质量下降的重要原因。国际头痛协会（IHS）在2018年推出了最新的头痛分类[1]。此后，关于头痛各方面的文章呈爆炸性增长。药物治疗是许多头痛治疗方案的重要组成部分。因此，在过去几十年中，市场上出现了许多新药物。这些药物包括曲坦类药物、吉泮类药物和其他被批准用于缓解偏头痛的药物[2-4]。然而，各种系统性因素和其他因素可能导致无法使用药物。有些患者可能难以接受传统的治疗方法[5-9]。对于其中一些难治性病例，人们提出了各种消融手术和其他侵入性方案。在这些头痛病例的特定群体中，各种周围神经阻滞和神经刺激的方法可以对患者的诊断、预后和生活质量产生明显的积极影响。在这篇文章中，我们回顾了特定患者群体所采用的神经和神经节阻滞手术的证据、适应证、临床解剖、标志、技术、风险和不良反应。我们鼓励读者参考本文中引用的文章以了解手术技术细节。IHS第3版头痛分类将三叉神经和其他脑神经痛纳入其头痛的分类中[1]。因此，尽管对于执业临床医生来说，神经痛可能并不符合“头痛”的传统定义，我们还是加入了神经阻滞治疗神经痛的一小节内容。
周围神经阻滞的原理是局部麻醉能够阻断传入神经。包括局部麻醉药（LA）和类固醇在内的各种药物制剂已被单独或联合用于这些手术。许多局部麻醉药能很好地阻断痛觉，而不明显地阻断运动功能。局部麻醉药的特性，如起效时间和麻醉持续时间可能会影响疼痛的缓解程度。还应注意麻醉剂阻断疼痛后可能产生的安慰剂效应，以及由此产生的麻木感[9,10]。
对于周围神经阻滞在头痛治疗中的适应证和使用时机，似乎没有真正的共识[11,12]。在实际的麻醉药物及其浓度、使用量、阻滞频率、连续阻滞之间的时间间隔，以及是否使用含皮质类固醇激素方面的观念也存在相当大的差异[11,13-15]。此外，头颈部的传入神经阻滞还可能有其他作用，因为它对来自原神经区域以外的其他组织区域疼痛有积极影响（典型例子：趋同现象）。周围神经阻滞术是微创手术，对许多患有头痛的患者或有很大治疗和管理价值[11]。周围神经阻滞大多耐受性良好，易被患者接受，且大多极少有或没有严重副作用[11,13]和不良反应[11,16-20]。许多神经阻滞手术缺乏真正严格的对照研究，部分或许是未经证实的“传闻”。
正如前面所提到的，颅面神经痛值得特别注意。IHS将这些病痛列入头痛，可能与疼痛部位分布于头颈部有很大关系。必须指出的是，神经痛的持续时间可能与普通的“头痛” 概念不一致。然而，像枕部神经痛这样的病痛，由于疼痛所涉及的头颈部面积较大，再加上持续时间和触发因素等原因，或许会被患者和临床医生视为头痛。涉及到三叉神经和舌咽神经痛时，由于疼痛症状可能具有“牙科”性质，患者通常会被转诊或自我转诊到牙医/面部疼痛专家处。我们根据《叙述性评论报告清单》发表以下文章（清单可在链接中获取：https://joma.amegroups.com/article/view/10.21037/joma-22-6/rc）。
二、方法
表1总结了用于识别潜在文献的详细方法。
表1 检索策略总结
1. 枕神经阻滞
枕神经阻滞被分别描述为枕小神经(C3)阻滞、枕大神经(C2)阻滞或联合(C2-C3)阻滞[21-24]。
（1）神经解剖与分布
脊髓C2和C3水平的背根神经节发出的感觉神经组成了“枕神经”[25,26]。这些神经支配从头皮后部到头顶的区域，包括外耳等其他解剖结构[26]。C2被称为枕大神经（greater occipital nerve，GON），C3被称为枕小神经，C3的一个分支连接C2-C3面关节[27]，该分支被称为第三枕神经（图1A）[25]。枕大神经C2起始于C1和C2椎体之间，并在两块肌肉，即下斜肌和头半棘肌之间通过[26]。这条神经穿过头半棘肌，有时穿过斜方肌和下斜肌，并与胸锁乳突肌连接[21,25,26]。枕小神经(lesser occipital nerve，LON)支配头外侧区域、耳及耳颅面后的头皮[25]。
图1 枕神经阻滞
(A)枕神经解剖；(B)枕大神经和枕小神经阻滞术。TON，third occipital nerve；GON，greater occipital nerve；LON，lesser occipital nerve。
（2）适应证
文献中关于神经阻滞适应证的叙述差异很大。部分文献提到枕大神经阻滞常规用于两种情况，即枕部神经痛和颈源性头痛。应指出，在此类疾病中枕大神经阻滞可以起到诊断、预后和（或）治疗的作用[1,9,12,22]。枕大神经阻滞在治疗丛集性头痛和偏头痛时也很有效。枕大神经阻滞也可用于C2卡压神经病的诊断和治疗[25]。枕大神经阻滞的其他适应证包括丛集性头痛、偏头痛、日常慢性头痛、持续偏头痛、日常持续性头痛、创伤后头痛、硬膜穿刺后头痛和三叉神经痛[28-36]。枕神经阻滞是治疗难治性枕神经痛的首选方案之一[23]。枕大神经阻滞可用于解剖学意义上不同的神经痛，如三叉神经痛是由于这两种神经在三叉神经尾状核水平上邻接[22,25,37,38]。据报道，就持续数月的慢性疼痛而言，单独或联合类固醇，枕大神经阻滞缓解疼痛的成功率为15%～35%[16,25,39]。文献中对于这种效果给出的解释是通过枕大神经传入阻滞抑制了三叉神经尾侧核和脊髓背角[37,39]。先兆性偏头痛的紧急治疗包括双侧枕大神经阻滞[40]。
（3）枕大神经阻滞适应证
枕大神经阻滞的适应证有枕神经痛、压迫性神经病、颈源性头痛、丛集性头痛(发作性和慢性)、偏头痛(发作性和慢性)、持续性偏头痛、日常慢性头痛、日常持续性头痛、创伤后头痛、硬膜穿刺后头痛和三叉神经痛[28-36]。
（4）标志
连接枕骨隆突和乳突的直线是枕大神经的解剖学标志。
（5）技术
关于枕大神经阻滞的技术文献中已有许多描述。最为广泛接受的枕大神经阻滞方法之一是在枕部突起外侧的压痛点进行局部注射。枕小神经阻滞是在触及的枕动脉外侧约1.5英寸（3.81 cm）处进行的（图1B）[14,41-46]。超声可以帮助在C1-C2间更准确的定位。尽管与没有任何图像引导的阻滞相比，其优势还有待证明[39,47,48]。
（6）药理学
许多文献聚焦于1%～2%的利多卡因或0.25%～0.5%的布比卡因[23,46]。联合肉毒毒素-A(Botox)显然比单独使用局部麻醉药阻滞的疼痛缓解时间更长[49,50]。肉毒毒素在枕大神经阻滞中产生持续疼痛缓解的作用机制包括对P物质、CGRP和谷氨酸的抑制[49,51-53]。
（7）不良反应
据推测，枕大神经阻滞的不良反应、副作用，可能来自于对局部组织或神经的直接创伤、药物的副作用或邻近血管损伤导致的局部出血。必须指出的是，这些不良反应大多是短暂且轻微的。极少报道的副作用包括血肿、注射部位的疼痛、脱发和局部注射部位感染[54]。临床医生应该意识到重复注射时可能出现更明显的局部不良反应，特别是使用类固醇时。极少数情况下，类固醇可引起局部组织坏死、肌肉萎缩和肌腱断裂[24,55]。双侧阻滞呈现出较高不良反应发生率。含有血管收缩药的麻醉药可能会导致头皮组织坏死，这与血管收缩药有关。这种影响被认为是枕部动脉血管收缩的结果[28]。
2. 第三枕神经
第三枕神经(TON)开始于C3神经的后支[25]。第三枕神经与C2-C3关节存在解剖学上的关系。众所周知，第三枕神经可以穿过头夹肌、斜方肌和头半棘肌。该神经还连接C2-C3关节的感觉神经[26]。一些文献提出使用第三枕神经阻滞来治疗加速性或减速性损伤（挥鞭伤）相关的疼痛[9,56,57]。值得一提的是，C3刺激也可用于枕部神经痛的治疗[22,58-61]。第三枕神经阻滞较常见的用途之一是治疗上颈椎疼痛和颈源性头痛[62]。
3. 蝶腭神经节阻滞
（1）神经的解剖和分布
蝶腭神经节（sphenopalatine ganglion，SPG）位于翼腭窝（pterygopalatine fossa，PPF）内。它有自主神经、感觉神经和运动神经[63]。翼管神经与交感和副交感神经纤维共同连接蝶腭神经节。节前副交感神经元的突触存在于蝶腭神经节内，之后，节后副交感神经纤维经由蝶腭神经节，通过第五神经的眼部和上颌部到达目标器官（泪腺、鼻腺、腭腺和咽腺）。节前交感神经纤维首先在颈上神经节存在突触，而后，节后交感神经纤维与副交感神经纤维共同通过蝶腭神经节（无突触）[63]。表2中描述了蝶腭神经节的感觉神经。
表2 蝶腭神经节分支[64]
（2）适应证
丛集性头痛被认为是由第七神经的唾液上核，多数情况下是通过蝶腭神经节，激活了副交感神经引起[65]。蝶腭神经节阻滞可有效治疗丛集性头痛和偏头痛[9,66-69]，也可有效治疗硬膜穿刺后头痛、创伤后头痛和带状疱疹后神经痛[68,70,71]。重复使用蝶腭神经节阻滞适用于对吲哚美辛不耐受的连续性偏头痛患者[68]。
（3）标志
可通过蝶腭孔进入翼腭窝，该孔处于鼻黏膜平面、中鼻甲后[64]。与蝶腭神经节有关的其他局部标志是中鼻甲和翼腭窝（上颌骨、腭骨和蝶骨交界处形成的锥体空间）[72]。
（4）技术
最初由Barré在1982年提出，蝶腭神经节阻滞可以使用不同浓度的可卡因溶液经鼻腔进行[73]。该技术只需让患者处于仰卧位，头向上倾斜，并在两鼻孔中均放置药物[74]。Kittrelle等人在1985年使用4%的二甲卡因进行了类似的操作[75]。该方法后被Berger等人再次证实[76]。蝶腭神经节阻滞中采用了经鼻、经口和经颧下三种传统方法[77]。还有一种新技术，采用颧骨上方法[78]。经口法是通过腭大孔直接阻断腭神经的方法。将27号弯牙针穿过上颌智齿内侧的腭大孔，通过位于翼腭窝上部的三叉神经V2部分的主干，即可到达翼腭窝[27,77,79]。蝶腭神经节阻滞经鼻法是让患者采取仰卧/躺卧位，用棉签在中鼻甲区域的鼻咽后壁上局部涂抹麻醉药（图2）[66,73,79]。蝶腭神经节阻滞的经颧下侧法通常由荧光镜或CT引导[27,79,80]。
图2 经鼻蝶腭神经节神经节阻滞术
（5）药理学
最常用的蝶腭神经节阻滞药物包括2%～4%的利多卡因、0.5%的布比卡因、4%的可卡因/去甲类固醇或6%的苯酚[79]。
（6）不良反应
蝶腭神经节阻滞最常见的不良反应是鼻出血，通常是由经鼻法和经颧骨下侧法导致[81]。其他不良反应包括由于在注射至翼腭窝上颌动脉或其分支导致的血肿，以及进行蝶腭神经节阻滞时口腔或鼻腔黏膜破损导致的感染[27]。上颌骨、腭部或咽部可能会出现暂时性感觉减退，因为这些区域的感觉传输受到蝶腭神经节阻滞的影响[82,83]。蝶腭神经节阻滞后，由于局部麻醉药从翼腭裂扩散影响下眼眶裂隙中的外展神经，患者出现短暂性复视现象很常见[84]。
4. 星状神经节阻滞
（1）神经解剖和分布
星状神经节（stellate ganglion，SG）由颈下神经节和第一胸交感神经节结合而成[85-89]。一般认为，星状神经节位于C7椎体和T1的交界处。头部、颈部和上肢的交感神经传导经由星状神经节的交感神经支配[90,91]。通过阻断星状神经节，同侧身体上部的交感神经传导被抑制。星状神经节位于C7椎体横突前和椎动脉后（图3A）[64]。节前交感神经纤维从脊髓T2或T3-T5穿行到星状神经节。汗腺、上肢血管、肺和心脏的神经分支以及椎动脉周围神经丛通过脊神经C7、C8和T1接收来自星状神经节的节后交感神经纤维[64,92]。通过阻断星状神经节，同侧的头、颈和上肢的血液供应会增加[93-95]。星状神经节阻滞可以减少对痛觉的感知，具有镇静作用，从而发挥减轻痛觉的作用[96,97]。
图3 星状神经节阻滞
(A) 星状神经节阻滞的解剖和针头位置；(B) 星状神经节阻滞技术。
（2）适应证
星状神经节阻滞已被用于治疗复杂区域疼痛综合征（CRPS Ⅰ型和Ⅱ型）[90,98-100]。一些文章提到星状神经节阻滞也可用于治疗颅面区域CRPS[101]和交感神经持续性疼痛[98,102,103]。该阻滞方法可有效控制疼痛，如带状疱疹和疱疹后神经痛[89,99,104-107]，还可有效治疗难治性偏头痛和紧张型头痛[99,108]、难治性非典型面部疼痛[90,93,109,110]和颞动脉炎[111,112]。最近，它被用于治疗灼口综合征[64,113]。
（3）标志
进行星状神经节阻滞时，最常用的标志是C6椎体、C6椎体横突上的Chassaignac小结、环状软骨和颈动脉[114]。对于超声引导技术，使用的软组织标志是颈动脉、颈内静脉、甲状腺、颈长肌、头长肌、椎前筋膜和C6脊神经根[114,115]。表3总结了这些解剖学标志。
表3 星状神经节的解剖关系[64,116]
（4）技术
目前已知的星状神经节阻滞方法有三种。施行星状神经节阻滞的传统盲法是通过识别和触诊C6横突上的Chassaignac小结，从而防止血管内注射。注射溶液可通过颈长肌扩散到星状神经节[90,117]。为避免发生椎动脉或肺部的血管内注射造成气胸，星状神经节阻滞需在C6水平进行（图3B）[118,119]。各种新技术已被用于实施星状神经节阻滞，如超声和透视引导[119-121]。这些技术使传统盲法几乎过时。荧光镜引导的星状神经节阻滞仅利用骨质标志，如C6椎体的横突。前后法是荧光镜引导技术中最常用的方法：推进针头，直到到达骨头（C6的横突小结），并在注射前抽出几毫米[119,122]。超声引导技术利用软组织标志和骨质标志来实施星状神经节阻滞。与透视技术不同的是，超声引导下的阻滞不接触骨头。在超声引导技术中，针头被放置在覆盖颈动脉鞘后部筋膜层的椎前筋膜和颈长肌之间的筋膜平面[119,122]。
（5）药理学
用于实施星状神经节阻滞的各种局部麻醉药有5 mL的0.5%布比卡因[123]、5 mL的0.5%甲哌卡因[124]，以及5 mL的1.5%利多卡因[99]。
（6）不良反应
星状神经节阻滞最常见的不良反应是发生于椎动脉、颈动脉、颈内静脉和甲状腺下动脉的血管内注射。不良反应在传统盲法和荧光镜引导下的星状神经节阻滞中更为常见[125]。透视技术下可能出现气胸、食管和气管穿刺[125]。超声引导下的星状神经节阻滞可以直接看到血管和软组织结构，如椎动脉、甲状腺下动脉、颈动脉、甲状腺、食管和神经根，这使得该手术相对安全，并将其他技术中可能出现的并发症降到最少[122,126]。其他不良反应包括短暂性霍纳综合征[127,128]、血肿、气道阻塞[129]，喉返神经、迷走神经和臂丛神经根的损伤[114]，还有严重高血压、短暂性咳嗽、呼吸困难、持续性眼睑下垂、半膈肌麻痹/膈神经损伤、硬膜穿刺、气胸、血肿和感染等[125,128-131]。
5. 眶上和滑车上神经阻滞
（1）神经解剖和分布
眶上和滑车上神经是三叉神经眼部（V1）的分支，支配眼眶和上眼睑等部分[9,132-136]。它们穿过眶上脊上方的眼眶，便于神经阻滞[9]。眶上神经由一凹槽从眶上缘离开[135,136]。滑车上神经沿眼眶内侧顶行进，在耳蜗和眶上孔之间，经过额部切迹，支配前额的深层组织[134]。
（2）适应证
眶上神经阻滞（supraorbital nerve blocks，SONs）和滑车上神经阻滞（supraorbital and supratrochlear nerve blocks，STNs）适用于慢性头痛的治疗[137]。阻滞这些神经也可用于有效治疗难治性额部头痛[138]。其他适应证包括急性偏头痛和偏头痛状态的治疗[139,140]。滑车上神经阻滞也可用于治疗涉及滑车神经的各种自身免疫疾病和炎症，如颅神经炎、多发性硬化症和Tolosa-Hunt综合征[141]。眶上神经阻滞可治疗游泳者头痛[141]。眶上神经阻滞和滑车上神经阻滞可用于治疗丛集性头痛[11]。文献中出现的眶上神经阻滞和滑车上神经阻滞的其他适应证包括眶上和滑车上神经痛、面部疼痛的诊断和管理、恶性肿瘤的姑息治疗，以及带状疱疹和面部骨裂引起的疼痛[27]。
（3）标志
眶上神经阻滞和滑车上神经阻滞的标志是眶上切迹、眼眶和皱眉肌[11,142-144]。
（4）技术
① 眶上神经阻滞
确定眶上切迹后，在目标区域插入25号针头，并向中线推进，距离眶上孔约15°，直至接触到骨膜（图4）[9，142，144-147]。
② 滑车神经阻滞
确定眼睛的内侧角后，从眉毛上方到眉毛下方的眼睛内侧角画一条假想线。在这条线的中点插入25号针头，然后推进，直至到达眶骨，回抽后，注射3 mL的麻醉药（图4）[9，144，147，148]。
图4 眶上和滑车上神经阻滞技术
（5）药理学
最常用于眶上和滑车上神经阻滞的麻醉药是0.5%或1%利多卡因和0.5%布比卡因[149-152]。
（6）不良反应
因为接近血管结构，眶上和滑车上神经阻滞后最常见的不良反应/并发症是注射后的血肿和瘀斑[141,149]。
6. 椎间关节注射
（1）神经的解剖和分布
椎间关节注射是头痛管理的一部分。椎间关节是一个带有纤维囊的滑膜关节(cervico zygapophyseal)。该关节的主要组成部分是颈椎的关节突和邻近椎体的下关节突[153,154]。C4-C8背神经的内侧分支连接椎间关节[155]。C3背脊的一个分支紧贴椎体，被称为第三枕神经，连接C3-C4关节突关节[156]。第三枕神经的阻滞用于缓解C2-C3关节的疼痛[27]。
（2）适应证
椎间关节疼痛、颈部疼痛、加速/减速损伤、手术后颈部疼痛、颈椎退行性关节病疼痛、颈源性头痛、其他颈椎病[27,157-160]。一些医生认为颈椎内侧支阻滞是诊断椎间关节疼痛的标准[161,162]。
（3）标志和技术
由于注射区域附近结构的敏感性，大多数文献持续探讨对于透视引导的需求。最常用的面关节注射技术是侧向注射法。让患者使用头枕侧身躺下，以避免颈部侧屈。识别椎间关节后，将22-25号脊柱针向后引入，注意不要将针推进椎间孔和椎管内。注射剂是局部麻醉药和类固醇。在目标区域总共注射1～1.5 mL[163]。该过程在X线影像引导下进行[157,158,163,164]。
（4）药理学
在进行椎间关节注射时，通常使用的药剂是局部麻醉药和类固醇。局部麻醉药包括1%利多卡因或0.5%布比卡因。类固醇如40%曲安奈德、甲基强的松龙、地塞米松和倍他米松[157,158,165]。
（5）不良反应
椎间关节注射的不良反应包括出血、血肿、椎动脉内注射、硬膜穿刺、脑膜炎、硬膜外脓肿、血管迷走神经晕厥、气胸、膈神经损伤导致麻痹、感染（如化脓性关节炎）和腰椎脓肿[157-159,164,166-168]。其他短暂性副作用有注射部位肿胀和疼痛[158]。表4总结了一般的并发症以及与特定阻滞有关的并发症。
表4 颅面神经阻滞并发症
三、结论和临床启示
神经阻滞作为一种公认的技术出现在文献中，有助于诊断、确定预后、缓解疼痛和管理头痛疾病。神经阻滞对受头痛影响的患者的生活质量有相当大的改善。这些阻滞技术可以极大地提高诊断的准确度，从而防止误诊，使得临床医生能够进行简捷的疼痛管理。未来有必要进一步开展回顾性和前瞻性研究，探讨各种类型的神经阻滞与其他传统方式相比在治疗头痛疾病方面的疗效。
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