Atlantooccipital and Atlantoaxial Joint Block for Cervicogenic Headache

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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.

Table 9.1 Sensitivity and Specificity of Diagnostic Criteria in Patients Fulfilling the Criteria for 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

Table 9.2 Summary of Minimum Requirements for Diagnosis of Cervicogenic Headache

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: