Abstract
BackgroundCervicogenic headaches (CGH) are proven clinical entities. The prevalence of CGH arising from the atlanto-occipital (AO) joint is unknown. The best evidence for treatment of CGH is for third occipital nerve radiofrequency neurotomy. Treatment of CGH includes intra-articular injections into upper cervical spine joints. ObjectiveTo perform a review of the anatomy and clinical presentation of AO joint (AOJ) pain referral as well as a technical description to safely access the AOJ. MethodsA literature review was performed to explore the intricacies of the cranio-cervical junction (CCJ) with a focus on the relation between the AOJ and vascular anatomy. Our technical approach is described with complementary images. ResultsThe AOJ lies anterior to a venous sinus and slightly superior to the horizontally oriented vertebral artery crossing the joint line. ConclusionThe authors propose a modified superior needle trajectory that seeks to avoid these vascular structures and to access the AOJ safely.
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