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.
Highlights
Introduction cervical spineFeatures of Cervicogenic headache (CGH) headache can be similar to other primary headache disorders such as migraine, tensiontype headache, and related cranial neuralgias such as occipital neuralgia
The study results suggested that cervical epidural steroid injection (CESI) could be beneficial in the treatment of CGH, as the authors hypothesized that this pain syndrome continued its course by “sensitizing the cervical nerve roots” and “initiating a pain-producing loop” involving nerve root and microvascular inflammation as well as mechanically-induced micro-injury
It is currently not possible to determine whether the pain generator is somatic referred or radiculartype pain, other than to attempt blockade of cervical nerve root, facet joint, atlantoaxial, myofascial trigger point, or occipital nerve steroid injection
Summary
Introduction cervical spineFeatures of CGH headache can be similar to other primary headache disorders such as migraine, tensiontype headache, and related cranial neuralgias such as occipital neuralgia. The diagnostic criteria for CGH headache put forth by the International Headache Society (IHS) are as follows [1]: A. Pain, referred from a source in the neck and perceived in one or more regions of the head and/or face, fulfilling criteria C and D;. B. Clinical, laboratory, and/or imaging evidence of a disorder or lesion within the cervical spine or soft tissues of the neck known to be, or generally accepted as, a valid cause of headache;. C. Evidence that the pain can be attributed to the neck disorder or lesion based on at least one of the following: 1) Demonstration of clinical signs that implicate a source of pain in the neck; 2) Abolition of headache following diagnostic blockade of a cervical structure or its nerve supply using placebo- or other adequate controls;. Pain resolves within three months after successful treatment of the causative disorder or lesion
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