Upper Cervical Facet Joint and Spinal Rami Blocks for the Treatment of Cervicogenic Headache

Headache: The Journal of Head and Face Pain
Early View (Articles online in advance of print)

Published Online: 28 Jan 2010
Brief Communications
Linqiu Zhou, MD; Zarinah Hud-Shakoor, DO; Christopher Hennessey, PA-C; Avi Ashkenazi, MDFrom the Thomas Jefferson University – Neurology, Philadelphia, PA, USA (A. Ashkenazi); Thomas Jefferson University – Rehabilitation Medicine, Philadelphia, PA, USA (L. Zhou and Z. Hud-Shakoor); Underwood Memorial Hospital – Orthopedic Surgery, Woodbury, NJ, USA (C. Hennessey).
Correspondence to L. Zhou, 1225 North Broad Street, Suite 3, Woodbury, NJ 08096, USA. 

ABSTRACT

(Headache 2010;••:••-••)

Objective.—To evaluate the efficacy of upper cervical facet joint injections and spinal rami blocks in the treatment of cervicogenic headache.

Background.—Cervicogenic headache has been recognized as a common and often disabling disorder. The treatment of this headache type remains challenging.

Methods.—We conducted a retrospective chart review of 31 patients with refractory cervicogenic headache who underwent fluoroscopically guided C1/2, C2/3 facet joint injections and C2, C3 spinal rami blocks using a mixture of 0.25% bupivacaine and 3 mg betamehtasone. The outcome measures were the change in headache severity, assessed using an 11-point numerical pain scale, after treatment, and the duration of head pain relief.

Results.—Twenty-eight (90.3%) patients experienced >50% headache relief after treatment, with an average duration of 21.7 (1-90) days. Mean (±SD) head pain intensity decreased from 7.5 ± 1.3 before treatment to 2.7 ± 1.9 immediately after it (P < .0001). The procedures were well tolerated.

Conclusions.—C1/2, C2/3 facet joint injections and C2, C3 spinal rami blocks were effective and well tolerated for the treatment of cervicogenic headache in this study. The procedures provided significant and prolonged pain relief in the majority of patients. Larger controlled studies are needed to further evaluate the efficacy of this treatment modality in cervicogenic headache.