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Third occipital nerve headache: a prevalence study

S M Lord1, L Barnsley, B J Wallis

  • 1University of Newcastle, Spine Research Unit, Faculty of Medicine, Callaghan, NSW, Australia.

Journal of Neurology, Neurosurgery, and Psychiatry
|October 1, 1994
PubMed
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Third occipital nerve headache is common in whiplash patients with chronic neck pain. Diagnostic nerve blocks are essential, as clinical features alone do not reliably identify this condition.

Area of Science:

  • Neurology
  • Pain Medicine
  • Musculoskeletal Disorders

Background:

  • Chronic neck pain and headache are common sequelae of whiplash injury.
  • The third occipital nerve is a potential source of referred pain in the head and neck.

Purpose of the Study:

  • To determine the prevalence of third occipital nerve headache in patients with chronic neck pain following whiplash.
  • To evaluate the diagnostic utility of third occipital nerve blocks.

Main Methods:

  • A series of 100 whiplash patients with chronic neck pain were assessed.
  • Diagnostic nerve blocks using lignocaine and bupivacaine were performed on the third occipital nerve.
  • Diagnosis was confirmed by complete and prolonged pain relief following nerve blocks.

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Main Results:

  • The prevalence of third occipital nerve headache was 27% in all whiplash patients and 53% in those with dominant headache.
  • No specific historical or examination features reliably predicted the diagnosis before nerve blocks.
  • Tenderness over the C2-3 zygapophysial joint was significantly associated with a positive diagnosis (p=0.01).

Conclusions:

  • Third occipital nerve headache is a frequent cause of headache in patients with chronic neck pain after whiplash.
  • Third occipital nerve blocks are crucial for accurate diagnosis.
  • Clinical assessment alone is insufficient for diagnosing third occipital nerve headache.