Cervicogenic headaches: radiofrequency neurotomy and the cervical disc and fusion.

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.