title: The lateral atlanto-axial joint as a source of headache in congenital atlanto-occipital fusion.
abstract: A 47-yr-old woman presented with severe right-sided neck pain and headache, predominantly in the right-occipital region, for 3 yrs. The symptoms persisted despite using nonsteroidal antiinflammatory medications and undergoing physical therapy. The patient's examination was unremarkable except for reduced neck motion and prominent right-occipital tenderness. Imaging showed congenital fusion of the atlanto-occipital joints bilaterally. A fluoroscopically guided diagnostic right-lateral atlanto-axial joint injection was positive. We are reporting the first case of clinically proven lateral atlanto-axial joint arthropathy with neck pain and headache in a patient with congenital atlanto-occipital joint fusion. Subsequently, the patient received a set of two therapeutic lateral atlanto-axial joint injections. She had remarkable improvement of her headache and neck pain. At 1-yr follow-up, the patient continued to have significant improvement of the right-sided neck pain and headache.
authors.affiliation: Spaulding-Wellesley, Wellesley, Massachusetts, USA.
authors.forename: Omar H
authors.initials: OH
authors.lastname: El Abd
authors.forename: Darren
authors.initials: D
authors.lastname: Rosenberg
authors.forename: Lorraine
authors.initials: L
authors.lastname: Gomba
authors.forename: Zacharia
authors.initials: Z
authors.lastname: Isaac
mesh_terms: D018771:Arthralgia / Q000209:etiology*; D001268:Atlanto-Axial Joint / Q000473:pathology; D001269:Atlanto-Occipital Joint / Q000002:abnormalities* / Q000473:pathology; D005260:Female; D006261:Headache / Q000209:etiology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D019547:Neck Pain / Q000209:etiology*; D053591:Referred Pain; D014057:Tomography, X-Ray Computed