Poster 203: Cervical C1-2 and C2-3 Facet Joints and Dorsal Rami Injections for the Diagnostic and Therapeutic Tools for Cervicogenic Headache

Abstract

Cervical C1-2 and C2-3 Facet Joints and Dorsal Rami Injections for the Diagnostic and Therapeutic Tools for Cervicogenic Headache. Linqiu Zhou, MD, MS (Jefferson Pain Ctr, Thomas Jefferson University, Philadelphia, PA); Avi Ashkenazi, MD. Disclosure: L. Zhou, None; A. Ashkenazi, None. Setting: Tertiary care university teaching hospital. Patients: 13 patients with cervicogenic headache (5 men, 8 women; mean age, 41y; range, 18 62y). All patients had failed multiple pharmacologic and other treatments prior to the study. Average disease duration was 10.5 years (range, 1.5 27y). 6 patients had a unilateral headache and 7 had bilateral headache. All patients underwent a cervical magnetic resonance imaging (MRI). In 7, MRI demonstrated degenerative disk disease or herniated disk, most commonly at C5-6. Case Descriptions: All patients underwent fluoroscopic guided C1-2 and C2-3 facet joints injections and C2-3 dorsal rami injections. Assessment/Results: 12 (92%) of 13 patients experienced greater than 50% headache relief, with an average duration of 4.5 weeks (range, 2 6wk) from the first injection. C1-2 and C2-3 injections provided a long duration of pain relief. The response to C1-2 and C2-3 injections also supports the diagnosis of cervicogenic headache. Discussion: The diagnosis and treatment of cervicogenic headache are challenging. C1-2 and C2-3 facet joints and C2-3 dorsal rami injections are performed for diagnostic and therapeutic purposes in patients with cervicogenic headache. However, few data are available about their efficacy for this indication. C1-2 and C2-3 facet joints and dorsal rami blocks provided a significant and prolonged pain relief in the majority of patients in this study. The procedure also had a diagnostic value for these patients with cervicogenic headache. Further studies are needed to compare the efficacy of blocking the facet joint versus the dorsal rami in the treatment of these patients. Conclusions: C1-2 and C2-3 facet joints and C2-3 dorsal rami injections provide diagnostic and therapeutic values for cervicogenic headache.