Cervical Facet Arthropathy and Occipital Neuralgia: Headache Culprits

CURRENT PAIN AND HEADACHE REPORTS

Volume 14, Number 6, 418-423, DOI: 10.1007/s11916-010-0151-5

J. D. Hoppenfeld

Abstract

Cervicogenic headache (CH) is pain referred from the neck. Two common causes are cervical facet arthropathy and occipital neuralgia. Clinical diagnosis is difficult because of the overlying features between primary headaches such as migraine, tension-type headache, and CH. Interventional pain physicians have focused on supporting the clinical diagnosis of CH with confirmatory blocks. The treatment of cervical facet arthropathy as the source of CH is best approached with a multidimensional plan focusing on physical therapy and/or manual therapy. The effective management of occipital neuralgia remains challenging, but both injections and neuromodulation are promising options.

Cervicogenic headache, Occipital neuralgia, Cervical facet arthropathy, Occipital nerve stimulation, Occipital nerve block

CURRENT PAIN AND HEADACHE REPORTS

Volume 14, Number 6, 418-423, DOI: 10.1007/s11916-010-0151-5

J. D. Hoppenfeld

Abstract

Cervicogenic headache (CH) is pain referred from the neck. Two common causes are cervical facet arthropathy and occipital neuralgia. Clinical diagnosis is difficult because of the overlying features between primary headaches such as migraine, tension-type headache, and CH. Interventional pain physicians have focused on supporting the clinical diagnosis of CH with confirmatory blocks. The treatment of cervical facet arthropathy as the source of CH is best approached with a multidimensional plan focusing on physical therapy and/or manual therapy. The effective management of occipital neuralgia remains challenging, but both injections and neuromodulation are promising options.

Cluster Headache: Diagnosis and Treatment

	Semin Neurol 2010; 30(2): 175-185 DOI: 10.1055/s-0030-1249226
© Thieme Medical Publishers

Combined occipital and supraorbital neurostimulation for the treatment of chronic migraine headaches: initial experience

Combined occipital and supraorbital neurostimulation for the treatment of chronic migraine headaches: initial experience
KL Reed 1 , SB Black 2 , CJ Banta II 3 & KR Will 1
1 Department of Anesthesiology, Presbyterian Hospital of Dallas, 2 Medical Director of Neurology, Baylor University Medical Center of Dallas, and 3 Department of Orthopedic Surgery, Presbyterian Hospital of Dallas, Dallas, TX, USA
Correspondence to Kenneth L. Reed MD, 8220 Walnut Hill Lane, Suite 202, Dallas, TX 75231, USA. Tel. + 1-214-345-5656, fax + 1-214-345-5698, e-mail klreed1@swbell.net
Copyright © 2009 International Headache Society


A novel approach to the treatment of chronic migraine headaches based on neurostimulation of both occipital and supraorbital nerves was developed and reduced to clinical practice in a series of patients with headaches unresponsive to currently available therapies. Following positive trials, seven patients with chronic migraine and refractory chronic migraine headaches had permanent combined occipital nerve–supraorbital nerve neurostimulation systems implanted. The relative responses to two stimulation programs were evaluated: one that stimulated only the occipital leads and one that stimulated both the occipital and supraorbital leads together. With follow-up ranging from 1 to 35 months all patients reported a full therapeutic response but only to combined supraorbital–occipital neurostimulation. Occipital nerve stimulation alone provided a markedly inferior and inadequate response. Combined occipital nerve–supraorbital nerve neurostimulation systems may provide effective treatment for patients with chronic migraine and refractory chronic migraine headaches. For patients with chronic migraine headaches the response to combined systems appears to be substantially better than occipital nerve stimulation alone.

Received 24 March 2009, accepted 26 July 2009
DIGITAL OBJECT IDENTIFIER (DOI)
10.1111/j.1468-2982.2009.01996.x About DOI