Clin Exp Rheumatol
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Cervicogenic headache is a relatively common pain syndrome related to functional and/or degenerative alterations of the cervical spine tract. Administration of steroid represents an effective therapy for this headache, due to the anti-inflammatory effects combined with its direct analgesic effects on the C fibers. The epidural injection of steroids, while requesting skilled personnel for its execution, gives short term (2-month) pain relief with few risks or side effects. Moreover, epidural steroids allow reduction of analgesic drug consumption.
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The concept that headache might stem from the neck is old. The term "cervicogenic headache" was coined in 1983. A new content was then given to this concept: cervicogenic headache (CEH) is in principle a unilateral headache, generally starting in the neck and "spreading" forwards. ⋯ These special features of CEH cannot be emphasised strongly enough. There are signs pertaining to the neck, such as reduced range of motion in the neck, mechanical precipitation mechanisms and ipsilateral shoulder/arm sensation (or even pain). Migraine without aura symptoms are less prominent than in migraine.
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Headaches that originate from pathology of the cervical spine, called "cervicogenic headache", have been debated, described, and treated by various researchers. This paper describes the use of radiofrequency neurotomy procedures to relieve cervicogenic headache at several strategic locations. Procedures listed include those to the greater occipital nerve territory, the C2 medial rami, and the cervical discs. Anatomy relevant to the innervation of the disc by way of the sympathetic chain is described and illustrated. ⋯ Each of the procedures discussed, or a combination of all of them, can alleviate cervicogenic headaches completely, as is our goal.
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Cervicogenic headache (CEH) has been said to be common among patients with idiopathic headache, but no information exists as to its prevalence among those who have not suffered whiplash or head injury. This study was designed to answer this question and in addition to determine whether headache relief could be achieved by blockade of the occipital nerves (greater and lesser occipital--GON, LON) in the upper neck, on the side habitually affected by the headache. ⋯ Injections of depot methylprednisolone into the region of the GON and LON produced complete relief of headache in 169 out of 180 patients with CEH for a period ranging from 10 to 77 days, the mean duration of relief being 23.5 days. However, similar relief of headache could be achieved in patients with attacks of strictly unilateral migraine or cluster headache, suggesting that local steroid injections by blocking the cervico-trigeminal relay, can arrest other forms of unilateral headache.