• Kathryn Giblin, Jordan L Newmark, Gary J Brenner, and Brian J Wainger.
• Massachusetts General Hospital, Boston, Massachusetts, USA.
• Pain Med. 2014 Mar 1;15(3):473-8.

ObjectiveTo describe a case of cervicogenic headache with associated autonomic features and pain in a trigeminal distribution, all of which responded to third occipital nerve radiofrequency ablation.DesignSingle case report.SettingMassachusetts General Hospital Center for Pain Medicine.PatientsA 38-year-old woman with history of migraines and motor vehicle accident.InterventionsRight third occipital nerve diagnostic blocks and radiofrequency lesioning.Outcome MeasuresPain reduction; physical findings, including periorbital and mandibular facial swelling, tearing, conjunctival injection, and allodynia; and use of opioid and non-opioid pain medicines.ResultsThe patient had complete relief of her pain and autonomic symptoms, and was able to stop all pain medications following a dedicated third occipital nerve lesioning.ConclusionsThis case illustrates the diagnostic and therapeutic complexity of cervicogenic headache and the overlap with other headache types, including trigeminal autonomic cephalgias and migraine. It represents a unique proof of principle in that not only trigeminal nerve pain but also presumed neurogenic inflammation can be relieved by blockade of cervical nociceptive inputs. Further investigation into shared mechanisms of headache pathogenesis is warranted.Wiley Periodicals, Inc.

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