Headache Plus: Trigeminal and Autonomic Features in a Case of Cervicogenic Headache Responsive to Third Occipital Nerve Radiofrequency Ablation. Issue 3 (8th January 2014)

• Record Type: Journal Article
• Authors: Giblin, Kathryn; Newmark, Jordan L.; Brenner, Gary J.; Wainger, Brian J.
• Is Part Of: Pain medicine. Volume 15:Issue 3(2014)
• Page Start: 473
• Page End: 478
• Publication Date: 2014-01-08
• Subjects: Pain -- Periodicals; Pain -- Treatment -- Periodicals; Analgesics -- Periodicals; Pain -- Periodicals; Pain Management -- Periodicals; Douleur -- Périodiques; Douleur -- Traitement -- Périodiques; Analgésiques -- Périodiques; Analgésique; Soulagement de la douleur; Périodique électronique (Descripteur de forme); Ressource Internet (Descripteur de forme); 616.047205
• DOI: 10.1111/pme.12334
• Languages: English
• ISSNs: 1526-2375

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <sec id="pme12334-sec-0001" sec-type="section"> <title>Objective</title> <p>To describe a case of cervicogenic headache with associated autonomic features and pain in a trigeminal distribution, all of which responded to third occipital nerve radiofrequency ablation.</p> </sec> <sec id="pme12334-sec-0002" sec-type="section"> <title>Design</title> <p>Single case report.</p> </sec> <sec id="pme12334-sec-0003" sec-type="section"> <title>Setting</title> <p>Massachusetts General Hospital Center for Pain Medicine.</p> </sec> <sec id="pme12334-sec-0004" sec-type="section"> <title>Patients</title> <p>A 38‐year‐old woman with history of migraines and motor vehicle accident.</p> </sec> <sec id="pme12334-sec-0005" sec-type="section"> <title>Interventions</title> <p>Right third occipital nerve diagnostic blocks and radiofrequency lesioning.</p> </sec> <sec id="pme12334-sec-0006" sec-type="section"> <title>Outcome Measures</title> <p>Pain reduction; physical findings, including periorbital and mandibular facial swelling, tearing, conjunctival injection, and allodynia; and use of opioid and non‐opioid pain medicines.</p> </sec> <sec id="pme12334-sec-0007" sec-type="section"> <title>Results</title> <p>The patient had complete relief of her pain and autonomic symptoms, and was able to stop all pain medications following a dedicated third occipital nerve lesioning.</p> </sec> <sec id="pme12334-sec-0008" sec-type="section"> <title>Conclusions</title> <p>This case illustrates the diagnostic and therapeutic complexity of cervicogenic headache and the overlap with other headache types, including trigeminal autonomic cephalgias and migraine. It represents a unique proof of principle in that not only trigeminal nerve pain but also presumed neurogenic inflammation can be relieved by blockade of cervical nociceptive inputs. Further investigation into shared mechanisms of headache pathogenesis is warranted.</p> </sec> </abstract>