The longitudinal effectiveness of lateral atlantoaxial intra-articular steroid injection in the treatment of cervicogenic headache.
OBJECTIVE
The most accepted mechanism of cervicogenic headache is referred pain from cervical structures innervated by the upper three cervical spinal nerves. The lateral atlantoaxial joint is not an uncommon cause of cervicogenic headache. In this retrospective study, we examined the effect of lateral atlantoaxial intra-articular steroid injection in managing 32 patients with cervicogenic headache who have a clinical picture suggestive of atlantoaxial joint pain.


METHODS
The data were collected retrospectively by reviewing the patient's medical records and pain questionnaires.


METHODS
A total of 115 patients with cervicogenic headache who were referred to our institute were identified. Of those patients, 32 had a clinical picture suggestive of atlantoaxial joint pain and subsequently underwent a diagnostic/therapeutic intra-articular block.


RESULTS
Fifteen of the 32 patients (46.8%) had a postprocedure pain score of 0 (95% CI = 17.5-72.1%). Twenty-six of the 32 patients (81.2%) had a decrease in their postprocedure pain score of 50% or more (95% CI = 62.4-97.6%). The mean preprocedure pain score was 6.8 and postprocedure was 2.2 (Bonferroni-adjusted P < 0.001). At 1 and 3 months, the mean pain scores were 1.9 (P < 0.001) and 3.6 (P < 0.008), respectively. However, at 6 months, the mean pain score was 3.7, and this was not statistically significant (P = 0.208).


CONCLUSIONS
Lateral atlantoaxial intra-articular corticosteroid injections may provide short-term analgesia for patients with pain originating from the lateral atlantoaxial joint.
Narouze
Samer N
SN
Pain Management Department, Cleveland Clinic Foundation, Cleveland, OH 44195, USA. narouzs@ccf.org
Casanova
Jose
J
Mekhail
Nagy
N
D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001268:Atlanto-Axial Joint / Q000000981:diagnostic imaging; D003287:Contrast Media / Q000008:administration & dosage; D006261:Headache / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology*; D006801:Humans; D007270:Injections, Intra-Articular; D008137:Longitudinal Studies; D010147:Pain Measurement / Q000187:drug effects; D011859:Radiography; D012189:Retrospective Studies; D013256:Steroids / Q000008:administration & dosage / Q000627:therapeutic use*
D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D003287:Contrast Media; D013256:Steroids