Clinical Sciences/Health Conditions
David W. Popok, MD
Pain Fellow
NYU Langone
Brooklyn, New York, United States
Aharon Benelyahoo, MD
Pain Medicine Physician
NYU Langone
New York, New York, United States
Neck tongue syndrome (NTS) is a condition commonly characterized as unilateral pain in the neck or occiput with sensory symptoms in the ipsilateral tongue often triggered by abrupt neck movements. NTS may result from temporary C1–C2 joint subluxation or spasm of nearby muscles, leading to irritation or compression of the C2 ventral ramus thus causing unilateral neck pain with tongue paresthesia. Though this condition is relatively uncommon with an estimated prevalence of 0.22%, there is scant clarity and understanding of diagnosis and management of this significant headache disorder. Here are two cases presenting in outpatient-clinic setting:
Case Description: 28-year-old female with history of depression, anxiety, chronic pain, migraines and endometriosis described 5 years of persistent left sided ear pain, jaw pain, midline spine and neck soreness and burning tongue pain along the tip of the jaw. Bilateral steroid temporomandibular joint (TMJ) injections had aggravated symptoms and trigger point injections in the trapezius helped ameliorate neck pain symptoms. Notable findings on physical exam include hypertrophy and tenderness to palpation to the left and right masseter, positive facet loading maneuver and left sided occipital ridge tenderness.
36-year-old female with no significant past medical history describes left sided persistent numbness of cheek and lateral left edge of tongue that has been ongoing over the last year. Patient described an associated sharp pain along jaw and neck. Notable findings on physical exam include positive facet loading maneuver and occipital ridge tenderness on the left.
Discussions:
These cases are imperative to facilitate further exploration in the classification, diagnosis and treatment of NTS as there maybe symptom overlap with cervicogenic headache or temporomandibular pathology.
Conclusions:
Greater awareness of NTS may not only reduce misdiagnosis but also highlight the need for further exploration to develop effective management and treatment strategies for this potentially debilitating condition.
