Upper cervical facet joint and spinal rami blocks for the treatment of cervicogenic headache.
OBJECTIVE
To evaluate the efficacy of upper cervical facet joint injections and spinal rami blocks in the treatment of cervicogenic headache.


BACKGROUND
Cervicogenic headache has been recognized as a common and often disabling disorder. The treatment of this headache type remains challenging.


METHODS
We conducted a retrospective chart review of 31 patients with refractory cervicogenic headache who underwent fluoroscopically guided C(1/2), C(2/3) facet joint injections and C(2), C(3) spinal rami blocks using a mixture of 0.25% bupivacaine and 3 mg betamehtasone. The outcome measures were the change in headache severity, assessed using an 11-point numerical pain scale, after treatment, and the duration of head pain relief.


RESULTS
Twenty-eight (90.3%) patients experienced >50% headache relief after treatment, with an average duration of 21.7 (1-90) days. Mean (+/-SD) head pain intensity decreased from 7.5 +/- 1.3 before treatment to 2.7 +/- 1.9 immediately after it (P < .0001). The procedures were well tolerated.


CONCLUSIONS
C(1/2), C(2/3) facet joint injections and C(2), C(3) spinal rami blocks were effective and well tolerated for the treatment of cervicogenic headache in this study. The procedures provided significant and prolonged pain relief in the majority of patients. Larger controlled studies are needed to further evaluate the efficacy of this treatment modality in cervicogenic headache.
Thomas Jefferson University - Rehabilitation Medicine, Philadelphia, PA, USA.
Linqiu
L
Zhou
Zarinah
Z
Hud-Shakoor
Christopher
C
Hennessey
Avi
A
Ashkenazi
D000293:Adolescent; D000328:Adult; D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D001175:Arthrography / Q000379:methods; D001268:Atlanto-Axial Joint / Q000187:drug effects / Q000503:physiopathology; D001269:Atlanto-Occipital Joint / Q000187:drug effects / Q000294:innervation / Q000503:physiopathology; D001623:Betamethasone / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000294:innervation; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D009619:Nociceptors / Q000187:drug effects / Q000502:physiology; D010147:Pain Measurement; D051298:Post-Traumatic Headache / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D012189:Retrospective Studies; D011984:Sensory Receptor Cells / Q000187:drug effects / Q000502:physiology; D013127:Spinal Nerves / Q000187:drug effects* / Q000503:physiopathology; D016896:Treatment Outcome; D055815:Young Adult; D021801:Zygapophyseal Joint / Q000187:drug effects* / Q000294:innervation / Q000503:physiopathology
D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D001623:Betamethasone; D002045:Bupivacaine