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Current Pain and Headache Reports
Published in: Current Pain and Headache Reports 9/2014

Open Access 01-09-2014 | Anesthetic Techniques in Pain Management (D Wang, Section Editor)

Treatment of Cervicogenic Headache with Cervical Epidural Steroid Injection

Authors: Eugene Wang, Dajie Wang

Published in: Current Pain and Headache Reports | Issue 9/2014

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Abstract

Cervicogenic headache (CGH) is defined as referred pain from various cervical structures innervated by the upper three cervical spinal nerves. Such structures are potential pain generators, and include the atlanto-occipital joint, atlantoaxial joint, C2-3 zygapophysial joint, C2-3 intervertebral disc, cervical myofascial trigger points, as well as the cervical spinal nerves. Various interventional techniques, including cervical epidural steroid injection (CESI), have been proposed to treat this disorder. And while steroids administered by cervical epidural injection have been used in clinical practice to provide anti-inflammatory and analgesic effects that may alleviate pain in patients with CGH, the use of CESI in the diagnosis and treatment of CGH remains controversial. This article describes the neuroanatomy, neurophysiology, and classification of CGH as well as a review of the available literature describing CESI as treatment for this debilitating condition.
Literature
1.
The International Classification of Headache Disorders: 2nd edition. Cephalalgia 2004; 24(Suppl 1):9–160.
2.
Silverman S. Cervicogenic headache: interventional, anesthetic, and ablative treatment. Curr Pain Headache Rep. 2002;6(4):311.CrossRef
3.
4.
Aprill C, Axinn MJ, Bogduk N. Occipital headaches stemming from the lateral atlanto-axial (C1–2) joint. Cephalalgia. 2002;22:15–22.PubMedCrossRef
5.
6.
7.
Lord SM, Barnsley L, Bogduk N. Percutaneous radiofrequency neurotomy in the treatment of cervical zygapophysial joint pain. Neurosurgery. 1995;36:732–9.PubMedCrossRef
8.
Govind J, King W, Baily B, Bogduk N. Radiofrequency neurotomy for the treatment of third occipital headache. J Neurol Neurosurg Psychiatry. 2003;74:88–93.PubMedCentralPubMedCrossRef
9.
Weiner RL, Reed KL. Peripheral neurostimulation for control of intractable occipital neuralgia. Neuromodulation. 1995;2:217–21. 1999.CrossRef
10.
Kapural L, Mekhail N, Hayek SM, et al. Occipital nerve electrical stimulation via the midline approach and subcutaneous surgical leads for treatment of severe occipital neuralgia: a pilot study. Anesth Analg. 2005;101:171–4.PubMedCrossRef
11.
Poletti CE, Sweet WH. Entrapment of the C2 root and ganglion by the atlantoepistrophic ligament. Clinical syndrome and surgical anatomy. Neurosurgery. 1990;27:288–91.PubMedCrossRef
12.
Grubb SA, Kelly CK. Cervical discography. Clinical implications from 12 years of experience. Spine. 2000;25:1382–9.PubMedCrossRef
13.
Travell J, Rinzler SH. The myofascial genesis of pain. Postgrad Med. 1952;11:425–34.PubMed
14.
Freund B, Schwartz M. Post-traumatic myofascial pain of the head and neck. Curr Pain Headache Rep. 2002;6:361–9.PubMedCrossRef
15.
Mehta M, Salmon N. Extradural block. Confirmation of the injection site by X-ray monitoring. Anesthesia. 1985;40:1009–12.CrossRef
16.
el-Khoury GY, Ehara S, Weinstein JN, et al. Epidural steroid injection. A procedure ideally performed under fluoroscopic control. Radiology. 1988;168:554–7.PubMedCrossRef
17.
Renfrew DL, Moore TE, Kathol MH, et al. Correct placement of epidural steroid injections. Fluoroscopic guidance and contrast administration. Am J Neuroradiol. 1991;12:1003–7.PubMed
18.
Hogan QH. Epidural anatomy examined by cryomicrotome section. Influence of age, vertebral level, and disease. Reg Anesth. 1996;21:395–406.PubMed
19.
American Society of Anesthesiologists Task Force on Chronic Pain Management; American Society of Regional Anesthesia and Pain Medicine. Practice Guidelines for Chronic Pain Management: An updated report by the American Society of Regional Anesthesia and Pain Medicine. Anesthesiology. 2010;112:810–33.CrossRef
20.•
Ferrante FM, Wilson SP, Iacobo C, et al. Clinical classification as a predictor of therapeutic outcome after cervical epidural steroid injection. Spine. 1993;18:730–6. This study provides evidence of CESI in the treatment of cervical radicular pain. PubMedCrossRef
21.
Strub WM, Brown TA, Ying J, et al. Translaminar cervical epidural steroid injection. Short-term results and factors influencing outcome. J Vasc Interv Radiol. 2007;18:1151–5.PubMedCrossRef
22.••
Martelletti P, Di Sabato M, Granata M, et al. Epidural corticosteroid blockade in cervicogenic headache. Eur Rev Med Pharmacol Sci. 1998;2:31–6. This is a prospective study that provides evidence of the short-term efficacy of CESI for CGH. PubMed
23.••
Ming-wei H, Ni J-X, Guo Y-N, et al. Continuous epidural block of the cervical vertebrae for cervicogenic headache. Chin Med J. 2009;122(4):427–30. This study utilized an interventional technique to target cervicogenic pain generators. It provides evidence of short- and long-term benefits of CESI for CGH.
24.
Abbasi A, Malhotra G, Malanga G, et al. Complications of interlaminar cervical epidural steroid injections. A review of literature. Spine. 2007;19:2144–51.CrossRef
25.
Stojanovic MP, Vu TN, Caneris O, et al. The role of fluoroscopy in cervical epidural steroid injections. An analysis of contrast dispersal patterns. Spine. 2002;27:509–14.PubMedCrossRef
Metadata
Title
Treatment of Cervicogenic Headache with Cervical Epidural Steroid Injection
Authors
Eugene Wang
Dajie Wang
Publication date
01-09-2014
Publisher
Springer US
Published in
Current Pain and Headache Reports / Issue 9/2014
Print ISSN: 1531-3433
Electronic ISSN: 1534-3081
DOI
https://doi.org/10.1007/s11916-014-0442-3

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