Upper Cervical Facet Joint and Spinal Rami Blocks for the Treatment of Cervicogenic Headache

Zhou, Linqiu; Hud-Shakoor, Zarinah; Hennessey, Christopher; Ashkenazi, Avi

doi:10.1111/j.1526-4610.2010.01623.x

Cited by 37 publications

(29 citation statements)

References 14 publications

(16 reference statements)

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“…The C3 level may be effectively blocked reducing the pain stemming from the C2-C3 zygapophysial joint [84]. Again, facet joint injections (C1-C2 and C2-C3) and spinal rami blocks (C2 and C3) performed in 31 individuals with "refractory" CeH resulted in significant relief [80]. Despite favorable reports [85], a randomized, double-blind study designed to address the efficacy of botulinum toxin in CeH in 28 patients showed negative results.…”

Section: Treatmentmentioning

confidence: 95%

“…The greater occipital nerve anesthesia proved ineffective for the treatment of chronic migraine [78,79], and therefore, serves as a differentiating tool. As for CeH, the cervical C1-C2 and C2-C3 facet joint blocks, as well as C2 and C3 spinal rami (including the lesser and third occipital nerves) blocks induced prolonged pain relief in more than 90% of the patients [80]. The greater occipital nerve can be easily blocked and serves as important diagnostic evidence if a temporary relief is obtained [81,82].…”

Section: Treatmentmentioning

confidence: 98%

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Headache and Neck

Vincent

2011

Curr Pain Headache Rep

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Cervicogenic headache (CeH) is a relatively common syndrome. The paroxysmal and rather intense head pain usually is unilateral, spreading from the back of the head to the frontal and temporal regions, and triggered by certain movements or sustained provocative head positions. Digital pressure over triggering areas at the upper nuchal area reproduces the spontaneous pain pattern. Available clinical criteria differentiate this picture from other headache disorders, although superposition may be present in some cases. The neck is involved with other pain disorders apart from CeH. Migraine may be induced by cervical trigger factors in some cases, and whiplash lesions produce CeH-like symptoms as well as others. Occipital neuralgia refers to pain restricted to the distribution of the affected nerve and should not be mistaken as CeH. There is no definite, universal treatment for CeH yet. Options include physical therapy, preventive medicines, anesthetic blocks, denervation procedures, and surgery. The treatment choice must be performed on individual basis.

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Section: Treatmentmentioning

confidence: 95%

Section: Treatmentmentioning

confidence: 98%

Headache and Neck

Vincent

2011

Curr Pain Headache Rep

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“…They concluded that these morphological changes were possibly the result of chronic vascular compression. In addition, several authors proposed that one of the most important structures involved in the pathogenesis of occipital headache is the lateral C1–C2 joint [131415]. Ehni and Benner [13] described a group of elderly patients suffering from an occipital neuralgic pain syndrome aggravated by neck motion due to degenerative changes in a C1–C2 arthrosis.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Severe Headache Following Cervical Posterior Surgical Fixation from C2 Distally

Tauchi

Kim

et al. 2016

Asian Spine J

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Study DesignRetrospective study.PurposeTo identify the prevalence of severe headache occurring after cervical posterior surgical fixation (PSF) and to evaluate the clinical and radiological findings associated with severe headache after surgery.Overview of LiteratureSeveral studies have reported on the axial pain after cervical surgery. However, to our knowledge, the incidence of severe headache after cervical PSF has not been elucidated.MethodsThe medical records and radiological assessment of patients who underwent surgical treatment from August 2002 to May 2012 were reviewed to identify the prevalence and risk factors for severe headaches occurring following PSF from C2 distally. Neck disability index scores (NDI) (the item for neck pain), the type of C2 screw, number of cervical fused levels (1–6), and smoking habit were calculated preoperatively and postoperatively. In addition, radiological parameters (T1 slope angle, C1/2 angle, C2–7 Cobb angle, C2–7 sagittal vertical axis and C1-implant distance) were assessed for all patients. Severe headache was defined as a high NDI headache score (>4 out of 5).ResultsEighty-two patients met the inclusion criteria. The mean age was 59.2 years (range, 21–78 years), and the mean number of fused levels was 5.1. The mean follow-up period was 2.9 years (range, 1–10.9 years). While only one severe headache occurred de novo postoperatively in a patient in the C3 or C4 distally group (total 30 patients, average age of 50.2 years), 11 patients in the C2 distally group (p=0.04) had severe headache occur postoperatively. The radiological parameters were not significantly different between the postoperative milder headache and severe headache (SH) groups. The SH group had a significantly higher preoperative NDI score (neck pain) (p<0.01).ConclusionsNewly occurring severe headaches can occur in 18% of patients after PSF from C2 distally. The patients with newly occurring severe headaches had significantly higher preoperative NDI score (neck pain).

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“…The selection of the site for injection was determined by first having the patient identify the more painful side [8, 11]. An Esaote MyLab60 (Esaote, Italy) ultrasound machine equipped with a multifrequency linear probe (4–13 MHz) was used.…”

Section: Methodsmentioning

confidence: 99%

“…Thus, several local anesthetic techniques have been used in treating CeH, including occipital nerve blocks, cervical facet joint blocks, and cervical epidural injections [8–11]. Real time fluoroscopy imaging guidance is frequently required to ensure correct needle placement [12–14].…”

Section: Introductionmentioning

confidence: 99%

Ultrasound-Guided versus Fluoroscopy-Guided Deep Cervical Plexus Block for the Treatment of Cervicogenic Headache

Wan

Yang

Xiao

et al. 2017

BioMed Research International

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Objective. The aim of this study was to compare the efficacy of ultrasound-guided deep cervical plexus block with fluoroscopy-guided deep cervical plexus block for patients with cervicogenic headache (CeH). Methods. A total of 56 patients with CeH were recruited and randomly assigned to either the ultrasound-guided (US) or the fluoroscopy-guided (FL) injection group. A mixture of 2–4 mL 1% lidocaine and 7 mg betamethasone was injected along C2 and/or C3 transverse process. The measurement of pain was evaluated by patients' ratings of a 10-point numerical pain scale (NPS) before and 2 wks, 12 wks, and 24 wks after treatments. Results. The blocking procedures were well tolerated. The pain intensity, as measured by NPS, significantly decreased at 2 wks after injection treatment in both US and FL groups, respectively, compared with that of baseline (P < 0.05). The blocking procedures had continued, and comparable pain relieving effects appeared at 12 wks and 24 wks after treatment in both US and FL groups. There were no significant differences observed in the NPS before and 2 wks, 12 wks, and 24 wks after treatment between US and FL groups. Conclusions. The US-guided approach showed similar satisfactory effect as the FL-guided block. Ultrasonography can be an alternative method for its convenience and efficacy in deep cervical plexus block for CeH patients without radiation exposure.

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Upper Cervical Facet Joint and Spinal Rami Blocks for the Treatment of Cervicogenic Headache

Cited by 37 publications

References 14 publications

Headache and Neck

Headache and Neck

Postoperative Severe Headache Following Cervical Posterior Surgical Fixation from C2 Distally

Ultrasound-Guided versus Fluoroscopy-Guided Deep Cervical Plexus Block for the Treatment of Cervicogenic Headache

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