title: Treatment of cervicogenic headache with cervical epidural steroid injection.
abstract: Cervicogenic headache (CGH) is defined as referred pain from various cervical structures innervated by the upper three cervical spinal nerves. Such structures are potential pain generators, and include the atlanto-occipital joint, atlantoaxial joint, C2-3 zygapophysial joint, C2-3 intervertebral disc, cervical myofascial trigger points, as well as the cervical spinal nerves. Various interventional techniques, including cervical epidural steroid injection (CESI), have been proposed to treat this disorder. And while steroids administered by cervical epidural injection have been used in clinical practice to provide anti-inflammatory and analgesic effects that may alleviate pain in patients with CGH, the use of CESI in the diagnosis and treatment of CGH remains controversial. This article describes the neuroanatomy, neurophysiology, and classification of CGH as well as a review of the available literature describing CESI as treatment for this debilitating condition.
authors.affiliation: Thomas Jefferson University Hospital, 834 Chestnut Street T150, Philadelphia, PA, 19454, USA.
authors.forename: Eugene
authors.initials: E
authors.lastname: Wang
authors.forename: Dajie
authors.initials: D
authors.lastname: Wang
mesh_terms: D000779:Anesthetics, Local / Q000627:therapeutic use*; D002574:Cervical Vertebrae / Q000033:anatomy & histology / Q000187:drug effects* / Q000503:physiopathology; D003937:Diagnosis, Differential; D006801:Humans; D007268:Injections, Epidural / Q000379:methods*; D019838:Neck Injuries / Q000188:drug therapy* / Q000503:physiopathology; D009407:Nerve Block / Q000379:methods; D010147:Pain Measurement; D018579:Patient Selection; D051298:Post-Traumatic Headache / Q000188:drug therapy* / Q000503:physiopathology; D011788:Quality of Life; D013127:Spinal Nerves / Q000033:anatomy & histology / Q000187:drug effects* / Q000503:physiopathology; D013256:Steroids / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local; D013256:Steroids
references.citation: J Neurol Neurosurg Psychiatry. 2003 Jan;74(1):88-93
references.pmid: 12486273
references.citation: Cephalalgia. 2002 Feb;22(1):15-22
references.pmid: 11993608
references.citation: Neurol Clin. 2004 Feb;22(1):151-71, vii
references.pmid: 15062532
references.citation: J Vasc Interv Radiol. 2007 Sep;18(9):1151-5
references.pmid: 17804778
references.citation: Spine (Phila Pa 1976). 2007 Sep 1;32(19):2144-51
references.pmid: 17762818
references.citation: Biomed Pharmacother. 1995;49(10):435-45
references.pmid: 8746069
references.citation: Spine (Phila Pa 1976). 1982 Jul-Aug;7(4):319-30
references.pmid: 7135065
references.citation: Neurosurgery. 1990 Aug;27(2):288-91
references.pmid: 2385345
references.citation: Cephalalgia. 2004;24 Suppl 1:9-160
references.pmid: 14979299
references.citation: Eur Rev Med Pharmacol Sci. 1998 Jan-Feb;2(1):31-6
references.pmid: 9825568
references.citation: Anesthesiology. 2010 Apr;112(4):810-33
references.pmid: 20124882
references.citation: Anesth Analg. 2005 Jul;101(1):171-4, table of contents
references.pmid: 15976227
references.citation: Reg Anesth. 1996 Sep-Oct;21(5):395-406
references.pmid: 8895998
references.citation: Spine (Phila Pa 1976). 2002 Mar 1;27(5):509-14
references.pmid: 11880836
references.citation: Neuromodulation. 1999 Jul;2(3):217-21
references.pmid: 22151211
references.citation: Postgrad Med. 1952 May;11(5):425-34
references.pmid: 14920327
references.citation: Spine (Phila Pa 1976). 1993 May;18(6):730-6
references.pmid: 8516703
references.citation: Chin Med J (Engl). 2009 Feb 20;122(4):427-30
references.pmid: 19302749
references.citation: Neurosurgery. 1995 Apr;36(4):732-9
references.pmid: 7596504
references.citation: Curr Pain Headache Rep. 2002 Oct;6(5):361-9
references.pmid: 12207849
references.citation: Anaesthesia. 1985 Oct;40(10):1009-12
references.pmid: 4061788
references.citation: AJNR Am J Neuroradiol. 1991 Sep-Oct;12(5):1003-7
references.pmid: 1719788
references.citation: Radiology. 1988 Aug;168(2):554-7
references.pmid: 2969118
references.citation: Spine (Phila Pa 1976). 2000 Jun 1;25(11):1382-9
references.pmid: 10828920
references.citation: Curr Pain Headache Rep. 2002 Aug;6(4):308-14
references.pmid: 12095466