بسم الله الرحمن الرحیم

CERVICO GENIC HEADACHE

DIANGNOSTIC CRITERIA

A. Pain, referred from a source in the neck and perceived in one or more regions of the head and/or face, fulfills criteria C and D. B. Clinical, laboratory, and/or imaging evidence of a disorder or lesion within the cervical spine or soft tissues of the neck is known to be, or generally accepted as, a valid cause of headache. C. There is evidence that the pain can be attributed to the neck disorder or lesion based on at least one of the following: 1. Demonstration of clinical signs that implicate a source of pain in the neck. 2. Abolition of headache following diagnostic block of a cervical structure or its nerve supply using placebo or other adequate controls. Abolition of headache means complete relief of headache, indicated by a score of 0 on a visual analog scale. D. Pain resolves within 3 months after successful treatment of the causative disorder or lesion.

ETIOLOGY

1. atlanto- occipital joint 2. atlanto- axial joint 3. c2-c3 zygapo physical joint 4. c2-c3 interver tebral disc 5. vpper cervical roots nerves

DIFFERENTIAL DIAGNOSIS

1. tension headache 2. migraine headache 3. cervico genic headache 4. poste rior fossa lesions 5. vertebral artery lesions

NEUROPHYSIOLOGY

FIGURE : The trigemino-cervical complex. (Reprinted with permission from Cleveland Clinic)

ATLANTO AXIAL JOINT PAIN 1. POST TRAUMATIC 2. OSTEO ARTHAITIS

CLINICAL PRESENTATION

DIAGNOSTIC BLOCK WITH INTRA –ARTICULAR INJECTION OF ANESTHETICS

TREATMENT: 1.INTRA-ARTICULAR STEROIDS 2.R.F LESIONING OF CAPSULE 3.AAJ ARTHRODESIS

C2-C3 ZYGAPO PHYSICAL JOINT THIRD OCCIPITAL HEADACHE

TREATMENT: THIRD OCCIPITAL NERVE NEUROLYSIS

OCCIPITAL NEURALGIA

A. Paroxysmal stabbing pain, with or without persistent ache between paroxysms, in the distribution(s) of the greater, lesser, and/or third occipital nerves. B. Tenderness over the affected nerve. C. Pain eased temporarily by local anesthetic block of the nerve.

ETIOLOGY: GREATER OCCIPITAL NERVE ENTRAPMENT EMERGING TRAPEZIUS

TREATMENT: PHARMACO THERAPY OCCIPITAL NEUROSTIMULATION SURGICAL NERVE RELEASE

C2 NEURALGIA

INTERMITANT LANCINATING PAIN WITH LACRIMATION CILIARY INJECTION AND RHINORRHEA

DIAGNOSIS: SELECTIVE C2 ROOT BLOCK

ETIOLOGY : AAJ DISORDERS

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