Chapter 9 Atlantooccipital and Atlantoaxial Joint Block for Cervicogenic Headache
Cervicogenic headache
Cervicogenic headache is defined a unilateral headache defined by the following characteristics:
Diagnostic Criteria for Cervicogenic Headache
Tables 9.1and 9.2 summarize the various levels of criteria and the minimum requirements for the diagnosis of cervicogenic headache.
Diagnostic Criteria | Specificity | Sensitivity |
---|---|---|
Major Symptoms and Signs | ||
Unilateral headache | 0 | 1.00 |
Pain triggered by neck movements and/or sustained awkward head positioning | 0.75 | 0.44 |
Pain elicited by external pressure over the greater occipital nerve (GON) or the ipsilateral upper, posterior neck region C2-C3 | 1 | 0.17 |
Ipsilateral neck, shoulder and arm pain of a rather vague, nonradicular nature | 0.88 | 0.65 |
Reduced range of motion in the cervical spine | 0.38 | 0.91 |
Pain Characteristics | ||
Pain episodes of varying duration or fluctuating continuous pain | 0.88 | 0.78 |
Moderate, nonexcruciating pain, usually of a nonthrobbing nature | 0.86 | 0.91 |
Pain starting in the neck, eventually spreading to the oculofrontotemporal area | 0 | 1.00 |
Other Important Criteria | ||
Anesthetic blockades of the GON or C2 root | 1.0 | 0.18 |
Patient has sustained neck trauma a relatively short time prior to the onset | 0.88 | 0.65 |
Minor, More Rarely Occurring, Nonobligatory Symptoms and Signs | ||
Rarely occurring nausea, vomiting, and photophobia and phonophobia | 0.88 | 0.48 |
Ipsilateral edema and, less frequently, flushing, mostly in the periocular area | 0.88 | 0.09 |
Dizziness | 0.75 | 0.26 |
“Blurred vision” in the eye ipsilateral to the pain | 1.00 | 0.22 |
Difficulty on swallowing | 0.88 | 0.09 |
Definitive for cervicogenic headache (CGH) | Precipitating factors as described by patient and observed by physician Positive result of anesthetic blockade Unilateral pain without side shift |
Combination of factors provisional/tentative for CGH | Reduced range of neck motion; ipsilateral shoulder/arm pain Positive result of anesthetic blockade Unilateral pain without side shift |
The major criteria of cervicogenic headache are as follows:
Characteristics of headache may be described as follows:
Other important characteristics are as follows:
Other features of lesser importance.
The following attack-related phenomena are rare and moderate when present:
Clinical Characteristics of Cervicogenic Headache
Cervicogenic headache has the following clinical characteristics: