Open AccessHeadache Plus: Trigeminal and Autonomic Features in a Case of Cervicogenic Headache Responsive to Third Occipital Nerve Radiofrequency Ablation
Author(s) -
Giblin Kathryn,
Newmark Jordan L.,
Brenner Gary J.,
Wainger Brian J.
Publication year - 2014
Publication title -
pain medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.893
H-Index - 97
eISSN - 1526-4637
pISSN - 1526-2375
DOI - 10.1111/pme.12334
Subject(s) - medicine , cervicogenic headache , trigeminal nerve , anesthesia , allodynia , trigeminal neuralgia , occipital neuralgia , migraine , nociception , neuropathic pain , neuralgia , hyperalgesia , receptor
Abstract Objective 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. Design Single case report. Setting M assachusetts G eneral H ospital Center for Pain Medicine.Patients A 38‐year‐old woman with history of migraines and motor vehicle accident.Interventions Right third occipital nerve diagnostic blocks and radiofrequency lesioning. Outcome Measures Pain reduction; physical findings, including periorbital and mandibular facial swelling, tearing, conjunctival injection, and allodynia; and use of opioid and non‐opioid pain medicines. Results 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. Conclusions 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.