Characteristics of patients successfully treated for cervicogenic headache by surgical decompression of the second...

We have recently reported 90% success in a series of patients undergoing microsurgical decompression of the second cervical (C2) nerve root and ganglion for cervicogenic headache. Review and analysis of our database was carried out in order to cull factors characterizing patients amenable to this surgical treatment. Thirty-five sequential C2 decompressions performed on 31 patients who were pain-free or significantly improved in follow-up were evaluated retrospectively. Preoperative factors and intraoperative findings were analyzed for prognostic significance. The diagnosis of cervicogenic headache was made using established criteria and success of CT-guided C2 anesthetic blockade in alleviating the headache. Numerous historical factors noted preoperatively including age, sex, history of trauma, autonomic symptoms, visual changes, and many others were not able to be well correlated with outcome in univariate analysis. Likewise, no strong correlation could be made for findings on physical examination. Thus, no specific prognostic factors could be established, other than the accepted diagnostic criteria and successful anesthetic blockade of the C2 root and ganglion. These factors should identify the subset of patients with cervicogenic headache predominantly due to C2 root or ganglion effect and thus may favor a surgical treatment.