title: Role of greater occipital nerve blocks and trigger point injections for patients with dizziness and headache.
abstract: BACKGROUND
  The trigeminocervical system is integral in cervicogenic headache. Cervicogenic headache frequently coexists with complaints of dizziness, tinnitus, nausea, imbalance, hearing complaints, and ear/eye pain. Controversy exists as to whether this constellation of symptoms may be cervically mediated.
  
  
  OBJECTIVE
  To determine whether a wider spectrum of cervically mediated symptoms exist, and to investigate a potential role of greater occipital nerve blocks (GON) and trigger point injections (TPI) in these patients.
  
  
  METHODS
  Retrospective review of GON/TPI performed in a tertiary otoneurology/headache clinic from May 2006 to March 2007 for suspected cervically mediated symptoms. Data included chief complaint, secondary symptoms, response to injection, pre-GON/TPI posterior vertex sensation changes to pinprick, cervical spine examination, and response to vibration of cervical and suboccipital musculature.
  
  
  RESULTS
  Total number of 147 patients were included. Chief complaints in decreasing frequency: dizziness (93%), tinnitus (4%), headache (3%), and ear discomfort (0.7%). Overall symptoms in decreasing frequency: dizziness (97%), headache (88%), neck pain (63%), tinnitus (23%), and ear discomfort (22%). Improvements after GON/TPI: neck range of motion (71%), headache (57%), neck pain (52%), ear discomfort (47%), dizziness (46%), and tinnitus (30%). Dizziness responders had neck position asymmetries (84%), reproducible dizziness by cervical and suboccipital musculature vibration (75%), and preinjection posterior vertex sensory changes (60%).
  
  
  CONCLUSIONS
  A wider spectrum of cervically mediated symptoms may exist by influence of trigeminocervical and vestibular circuitry through cervical afferent neuromodulation. Certain examination findings may help to predict benefit from GON/TPI.
authors: Department of Neurology, Cleveland Clinic Neurological Institute, Center for Headache and Pain, 9500 Euclid Avenue, Cleveland, OH 44195, USA. barone2@ccf.org
authors: Eric P
authors: EP
authors: Baron
authors: Neil
authors: N
authors: Cherian
authors: Stewart J
authors: SJ
authors: Tepper
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000779:Anesthetics, Local / Q000627:therapeutic use*; D000818:Animals; D001623:Betamethasone / Q000031:analogs & derivatives / Q000627:therapeutic use; D002045:Bupivacaine / Q000627:therapeutic use; D002648:Child; D004244:Dizziness / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D051298:Post-Traumatic Headache / Q000188:drug therapy* / Q000503:physiopathology; D012018:Reflex; D012189:Retrospective Studies; D061028:Trigger Points / Q000502:physiology*; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D005938:Glucocorticoids; C028994:betamethasone sodium phosphate; D001623:Betamethasone; D002045:Bupivacaine