Treatment of cervicogenic headache with cervical epidural steroid injection

Curr Pain Headache Rep. 2014 Sep;18(9):442. doi: 10.1007/s11916-014-0442-3.

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.

Publication types

  • Review

MeSH terms

  • Anesthetics, Local / therapeutic use*
  • Cervical Vertebrae / anatomy & histology
  • Cervical Vertebrae / drug effects*
  • Cervical Vertebrae / physiopathology
  • Diagnosis, Differential
  • Humans
  • Injections, Epidural / methods*
  • Neck Injuries / drug therapy*
  • Neck Injuries / physiopathology
  • Nerve Block / methods
  • Pain Measurement
  • Patient Selection
  • Post-Traumatic Headache / drug therapy*
  • Post-Traumatic Headache / physiopathology
  • Quality of Life
  • Spinal Nerves / anatomy & histology
  • Spinal Nerves / drug effects*
  • Spinal Nerves / physiopathology
  • Steroids / therapeutic use*
  • Treatment Outcome

Substances

  • Anesthetics, Local
  • Steroids