Treating Cervicogenic Pain

Learning Objectives

As a result of participating in this activity, learners will be able/better-able to:

• differentiate between migraines and cervicogenic pain,
• differentiate between cervicogenic headache and cervical disc herniation,
• use anesthetic blocks for the appropriate confirmation of structural contributions to cervicogenic headaches.

Desirable Physician Attributes

• Systems-based Practice [ACGME/ABMS] Awareness and responsiveness to larger context and system of health care, use of system resources
• Patient Care [ACGME/ABMS & IOM] Provide care that is compassionate, appropriate and effective for the treatment of health problems and the promotion of health
• Medical Knowledge [ACGME/ABMS] about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care
• Apply Quality Improvement [IOM} Identify errors and hazards in care; understand and implement basic safety design principles, such as standardization and simplification; continually understand and measure quality of care in terms of structure, process, and outcomes in relation to patient and community needs; and design and test interventions to change processes and systems of care, with the objective of improving quality
• Interpersonal and Communication Skills [ACGME/ABMS] Effective information exchange and teaming with patients, their families, and other health professionals

Accreditation & Designation

Release date: This activity was released 8/19/2022.

Termination date: The content of this activity remains eligible for CME Credit until 8/18/2025, unless reviewed or amended prior to this date.

Claiming Credit: Watch the entire presentation and complete the Improvement Plan/Evaluation.

Neurovations Education is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Neurovations Education designates this other activity (blended learning) for a maximum of 0.50 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

California Required CME on Pain Management and the Appropriate Treatment of the Terminally Ill
AB487 requires physicians licensed in California to complete a one-time CME activity for 12 hours of credits that addresses both pain management and the appropriate care and treatment of the terminally ill. This activity contributes to achievement of requirements with AB487.

Disclosure of Financial Relationships & Measures to Resolve of Conflicts of Interest

[Presenter] Lynn Kohan discloses the following financial relationships within the past 24 months: Institutional funding: Avanos, FUSMobile; Consulting: Avanos

No other person with control of, or responsibility for, the planning, delivery, or evaluation of accredited continuing education has, or has had within the past 24 months, financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

All relevant financial relationships have been mitigated. Materials were reviewed in advance of the activity by person(s) that do not have conflicts of interest related to the content. In some cases, content may have been modified as part of the review and mitigation process. All clinical recommendations are evidence-based and free of commercial bias (e.g., peer-reviewed literature, adhering to evidence-based practice guidelines).

Additional Reading

• Sjaastad O, Sounte C, Houdahl H, Breivic H, Gronback E. Cephalgia 1983; 3(4):249-256. 
• Narourze S. Practical approach to cervicogenic headache. In: Narouze S, Ed. Interventional Management of Head and Neck Pain. New York. NY: Springer Science and Business Media:2014:67-76.
• Blumenfield A, Siavoshi S. The challenges of cervicogenic headache. Current Pain and Headache Reports 2018; 22:47. 
• Headache Classification Committee of the International Headache Society (IHS). The international classification of headache disorders, 3rd edn. (beta version). Cephalgia. 2013;33(9):629-808. 
• Bogduk N and J Govind. Cervicogenic headache: an assessment of the evidence on clinical diagnosis, invasive tests, and treatment. Lancet Neurol 2009; 8: 959-69. 
• Meloche JP, Bergeron Y, Bellavance A, et al. Painful intervertebral dysfunction: Robert Maigne’s original contribution to headache of cervical origin. The Quebec Headache Study Group. Headache. 1993; 33: 328–324 
• Mehnert M, Freedman M. Update on the role of Z-joint injection and radiofrequency neurotomy for cervicogenic headache. PM&R. 2013; 5(3): 221−227. 
• Antonaci F, Ghirmai S, Bono S, Sandrini G, and Nappi G: Cervicogenic headache: evaluation of the original diagnostic criteria. Cephalalgia 2001; 21: pp. 573-583
• Bogduk N and J Govind. Cervicogenic headache: an assessment of the evidence on clinical diagnosis, invasive tests, and treatment. Lancet Neurol 2009; 8: 959-69 (Adapted from Cooper G et al. Cervical zygapophysial joint pain maps. Pain Medicine. 2007; 8: 344-353 –Blackwell Science) 
• Dreyfuss P, Michaelsen M, Fletcher D. Atlanto-Occipital and Lateral atlanto-Axial Pain Patterns. Spine 1994;19(10):1125-1131 
• Chua N, Halim W., Evers A, Vissers K. Whiplash patients with cervivogenic headache after lateral atlanto-axial joint pulsed radiofrequency treatment. Anesthesia and Pain Medicine. 2012;1(3):162-167. 
• Edlow BL, Wainger BJ, Frosch MP, Copen WA, Rathmell JP, Rost NS: Posterior circulation stroke after C1-C2 intraarticular facet steroid injection: Evidence for diffuse microvascular injury. Anesthesiology 2010; 112:1532–5 
• Eigueta M. et al. Anatomical Variations of the vertebral artery in the upper cervical spine: Clinical relevance for procedures targeting the C1/C2 and C2/C3 joints. Regional Anesthesia and Pain Medicine. 43(4):367-371, May 2018. 
• Narouze SN, Casanova J, Mekhail N. The longitudinal effectiveness of lateral atlantoaxial intra-articular steroid injection in the treatment of cervicogenic headache. Pain Medicine 2007; 8(2): 184-188. 
• Aprill C, Axinn MJ, Bogduk N. 2002. Occipital headaches stemming from the lateral atlanto-axial (C1-2) joint. Cephalalgia 22:15–22. 
• Dwyer A, Aprill C, Bogduk N: Cervical zygapophyseal joint pain patterns: I: A study in normal volunteers. Spine 1990;15:453-457.) 
• Centeno C. Techniques in Regional Anesthesia and Pain Management, Vol 8, No 1 (January), 2004: pp 10-16 
• Cedeño D. Comparisons of Lesion Volumes and Shapes Produced by a Radiofrequency System with a Cooled, a Protruding, or a Monopolar Probe, Pain Physician 2017; 20:E915-E922 • ISSN 2150-1149. 
• Govind, J et al. J Neurol Neurosurg Psychiatry 2003;74:88-93. 
• Van Eerd M et al. A Modified posterolateral approach for radiofrequency denervation of the medial branch of the cervical segmental nerve in cervical facet joint pain based on anatomical considerations. Pain Practice 2016; 17(5) 596-603. 
• Eigueta M. et al. Anatomical Variations of the vertebral artery in the upper cervical spine: Clinical relevance for procedures targeting the C1/C2 and C2/C3 joints. Regional Anesthesia and Pain Medicine. 43(4):367-371, May 2018 
• Cohen SP, Bajwa ZH, Kraemer JJ, Dragovich A, Williams KA, Stream J, Sireci A, McKnight G, Hurley RW: Factors predicting success and failure for cervical facet radiofrequency denervation: A multi-center analysis. Reg Anesth Pain Med 2007; 32:495–503
• Lord SM, Barnsley L, Bogduk N: The utility of comparative local anesthetic blocks versus placebo-controlled blocks for the diagnosis of cervical zygapophysial joint pain. Clin J Pain 1995; 11:208–13.
• Cohen SP, Strassels SA, Kurihara C, Forsythe A, Buckenmaier C, et al. Randomized study assessing the accuracy of cervical facet joint (medial branch) blocks using different injectate volumes. Anesthesiology 2010; 112:144-152.