Rebecca Barmherzig1,2, William Kingston3. 1. Women's College Hospital Centre for Headache, Division of Neurology, University of Toronto, Toronto, Canada. rebecca.barmherzig@sickkids.ca. 2. The Hospital for Sick Children, Division of Neurology, Department of Pediatrics, Toronto, M5G 1X8, Canada. rebecca.barmherzig@sickkids.ca. 3. Women's College Hospital Centre for Headache, Division of Neurology, University of Toronto, Toronto, Canada.
Abstract
PURPOSE OF REVIEW: Occipital neuralgia (ON) and cervicogenic headache (CGH) are secondary headache disorders with occipital pain as a key feature. Due to significant phenotypic overlap, differentiating ON and CGH from primary headache disorders such as migraine or tension-type headache, or other secondary headache disorders, can be clinically challenging. This article reviews the anatomy, clinical features, unique diagnostic considerations, and management approaches relating to ON and CGH. RECENT FINDINGS: Conservative therapeutic approaches are considered first-line. Anesthetic nerve blocks may have a dual role in both supporting diagnosis and providing pain relief. Newer minimally invasive procedures, such as pulsed radiofrequency (PRF) and occipital nerve stimulation (ONS), represent an exciting therapeutic avenue for severe/refractory cases. Surgical interventions should be reserved for select patient populations who have failed all other conservative and minimally invasive options, to be weighed against potential risk. ON and CGH represent an ongoing diagnostic challenge. Further studies are required to consolidate efficacy regarding the comprehensive management of ON and CGH.
PURPOSE OF REVIEW: Occipital neuralgia (ON) and cervicogenic headache (CGH) are secondary headache disorders with occipital pain as a key feature. Due to significant phenotypic overlap, differentiating ON and CGH from primary headache disorders such as migraine or tension-type headache, or other secondary headache disorders, can be clinically challenging. This article reviews the anatomy, clinical features, unique diagnostic considerations, and management approaches relating to ON and CGH. RECENT FINDINGS: Conservative therapeutic approaches are considered first-line. Anesthetic nerve blocks may have a dual role in both supporting diagnosis and providing pain relief. Newer minimally invasive procedures, such as pulsed radiofrequency (PRF) and occipital nerve stimulation (ONS), represent an exciting therapeutic avenue for severe/refractory cases. Surgical interventions should be reserved for select patient populations who have failed all other conservative and minimally invasive options, to be weighed against potential risk. ON and CGH represent an ongoing diagnostic challenge. Further studies are required to consolidate efficacy regarding the comprehensive management of ON and CGH.
Authors: Hans van Suijlekom; Jan Van Zundert; Samer Narouze; Maarten van Kleef; Nagy Mekhail Journal: Pain Pract Date: 2010 Mar-Apr Impact factor: 3.183
Authors: Laura Rapisarda; Michele Trimboli; Francesco Fortunato; Antonio De Martino; Oreste Marsico; Giulio Demonte; Antonio Augimeri; Angelo Labate; Antonio Gambardella Journal: Neurol Sci Date: 2021-01-27 Impact factor: 3.307