S19_11

Cervicogenic headaches: Radiofrequency neurotomy and the cervical disc and fusion

H.G. Blume

University of South Dakota, Sioux City, Iowa, USA.

ABSTRACT
Objective
Headaches that originate from pathology of the cervical spine, called “cervicogenic headache”, have been debated, described, and treated by various researchers. This paper describes the use of radiofrequency neurotomy procedures to relieve cervicogenic headache at several strategic locations. Procedures listed include those to the greater occipital nerve territory, the C2 medial rami, and the cervical discs. Anatomy relevant to the innervation of the disc by way of the sympathetic chain is described and illustrated.

Methods
Radiofrequency neurotomy procedures were performed following either a successful nerve block in either the distribution of the greater occipital nerve or the C2 medial rami, or after provocative cervical discography. Cervical disc and fusion surgery is being correlated to the nerve supply of the discs and ligaments.

Results
The majority of patients suffering from cervicogenic headaches can be totally relieved for a lifetime, especially if the pain is unilateral. A very, very small percentage of these patients cannot be helped. The remaining sufferers have a considerable reduction in the intensity and frequency of pain.

Discussion
Each of the procedures discussed, or a combination of all of them, can alleviate cervicogenic headaches completely, as is our goal.

Key words
Cervicogenic headache, sympathetic chain, sinu-vertebral nerves, radiofrequency neurotomy, C2 medial rami, sub-occipital nerve territory, cervical disc and fusion, cervical discography.

Please address all correspondence and requests for reprints to: H.G. Blume, Former Clinical Associate Professor, University of South Dakota, 700 Jennings, Sioux City, Iowa 51105, USA.
E-mail: hblume@pionet.net