Role of the C2 articular branches in occipital headache: an anatomical study

One of the most important structures involved in the pathogenesis of occipital headache is the lateral atlanto-axial joint. Previous studies demonstrated that injection of this joint with local anesthetic can alleviate occipital headache, while injection of contrast medium exacerbates it. The aim of our study is to improve the understanding of the nerve supply to the lateral atlanto-axial joint by the C2 nerve elements, in order to determine the optimal target for an anesthetic block of this area. Ten C2 spinal nerves and roots were dissected in five embalmed cadavers with the aid of a 40X microscope and the lateral atlanto-axial joint was shown to be extensively supplied by articular branches of C2 nerve elements (dorsal ganglion, spinal nerve, and ventral ramus). Following our observations on their distribution, we propose a target for local anesthetic injection of the C2 articular branches that is based on reliable landmarks and is easily identifiable at fluoroscopy. We suggest that local anesthetic injection at this target point could be of benefit in the relief of occipital pain due to cervical trauma or degenerative disease involving the lateral atlanto-axial joint.