Headache Plus: Trigeminal and Autonomic Features in a Case of Cervicogenic Headache Responsive to Third Occipital Nerve Radiofrequency Ablation: Table 1

Abstract

This 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.

Differential diagnosis and treatment of bilateral facial pain after whiplash: a case report

“…In theory, a dysfunction in any tissue providing afferent input to C1-C3 could generate facial symptoms via this convergence (Bogduk, 1992). In a recent study, a woman with pain in a trigeminal nerve distribution and autonomic symptoms after whiplash received complete relief after radiofrequency ablation of the third occipital nerve (Giblin, Newmark, Brenner, and Wainger, 2014). Excessive mobility in this area of the cervical spine after whiplash has also been reported in the literature (Kristjansson, Leivseth, Brinckmann, and Frobin, 2003).…”

Diagnostic Value of Single-Photon Emission Computed Tomography/Computed Tomography Scans with Tc-99m HDP in Cervicogenic Headache

“…However, these methods are not always accurate [23]. The symptoms of CEH overlap with those of a tension-type headache and a migraine [5,[7][8][9][10]. Although MRI allows the identification of disc protrusion, dorsal ligament thickening, dural compression with spinal stenosis, and nerve compression, and can confirm these changes in the facet joint capsule, these findings are not pathognomonic of CEH.…”

“…Pathognomonic features of CEH include unilateral pain radiating from the neck to head, a temporal pain pattern, and pain induced by improper motion and external pressure on the neck [5,6]. However, the clinical features of CEH overlap with those of a tension-type headache or a migraine [5,[7][8][9][10]. Moreover, even healthy individuals may experience CEH [11].…”

Third Occipital Nerve Entrapment

“…There are case reports of good response to RFL, such as the report by Giblin et al [ 32 ]; they described a patient with trigeminal autonomic cephalgia who underwent right TON diagnostic injections and then RFL, with "complete" relief. Hamer and Purath [ 33 ] reported on 40 refractory cervicogenic headache patients treated with RF of the C2 dorsal root ganglion and/or TON; they described that 35 % of the patients reported 100 % relief and 70 % reported 80 % or more relief.…”