Therapeutic zygapophyseal joint injections for headaches emanating from the C2-3 joint.

OBJECTIVE: To report our experience using fluoroscopically guided therapeutic intra-articular C2-3 zygapophyseal joint injections in patients with chronic headaches after a whiplash event.
DESIGN: Restrospective study (n = 18 patients) with independent clinical review. Each patient experienced persistent daily headache symptoms which failed to improve after at least 3 mo of physical therapy, activity restriction, and the use of oral analgesics. Each patient demonstrated initially a positive response to a diagnostic intra-articular C2-3 joint injection. Data collection and analysis were performed by an independent clinical reviewer. Outcome measures included headache frequency, medication usage, symptom response to medication, and employment status.
RESULTS: Patients' symptom duration before diagnostic injection averaged 34 mo. Follow-up data collection transpired at an average of 19 mo after the final therapeutic injection. In 61% of patients, fewer than three headaches were experienced each week; these headaches were relieved with the use of oral analgesics.
CONCLUSIONS: Although the inherent limitations of this study preclude a definitive statement regarding the efficacy of C2-3 injections, these initial findings suggest that therapeutic intra-articular zygapophyseal joint injections are effective in the treatment of headaches emanating from the C2-3 joint after a whiplash event. Future controlled, prospective studies are necessary to clarify the role of such injections in this challenging patient population.