Cervicogenic Headache Diagnosis explained by Zinovy Meyler D.O., Princeton Spine & Joint Center:
When I see a patient, in terms of diagnosing this issue, the first thing is the symptoms that the patient experiences. That’s a very important part of the diagnosis, which is then followed by the signs that I can elicit on the physical examination. Once that is put together, that actually tends to be the major portion of the diagnosis in which everything else will dictate whether we’re going in the right path or if we need to take a look at a different source of the pain. Sometimes I will need to consider getting imaging studies such as an X- ray CT scan or an MRI depending on what’s appropriate for the given patient and a given situation.
When I’m ordering these studies, I’m not looking to find a specific source of that pain. I’m looking to first exclude any other reasons for the pain to be there. And then I’m looking for all the proper anatomy to be intact; alignment, different types of arthropathies, etc. So once we have the imaging, the symptoms, and the signs, that really points me in the direction of very high suspicion that this may very well be cervicogenic headache.
The treatment can proceed from this point or at times, to be even more precise, What I do is I do a very precise and specific block of that medial branch. And the way that’s done is in controlled conditions under the guidance of fluoroscopy or an x ray, a very small amount of medication is deposited at the usual location of the nerve. And what I’m looking to see is the response of the patient. And usually what’s targeted is the third occipital nerve, which is usually the most commonly involved nerve in this in this situation. If the patient has a very significant improvement with this block, then that really serves as a confirmation of the fact that this pain truly is cervicogenic in nature. In other words, that the headache actually does come from the neck.