Outcome of surgical decompression of the second cervical root for cervicogenic headache

There is limited information on the surgical treatment of cervicogenic headache (CH). The objective of this study is to analyze the utility of microsurgical decompression of the second cervical (C2) root and ganglion as a treatment for CH.

Thirty-nine sequential C2 root and ganglion decompressions, performed for the treatment of CH on 35 patients at the Dartmouth-Hitchcock Medical Center during a 70-month period, were analyzed retrospectively. Preoperative factors and intraoperative findings were evaluated with respect to outcome.

At a mean follow-up of 21 months, 12 patients (13 sides) were pain free, and 15 were adequately improved (18 sides). Treatment eventually failed in eight patients. No patient, however, was worse after surgical intervention. There was no major morbidity or mortality associated with the operation. The eight patients with unsatisfactory outcome were evaluated for a possible second operation, and four underwent it. One patient of the four is pain free after 28 months, and two gained adequate improvement at 3 and 12 months. The fourth patient required a third operation but has achieved adequate relief at 6 months. Thus, the overall success rate (either pain free or with adequate improvement) was 90%. No specific prognostic factors could be established, other than the accepted diagnostic criteria and successful anesthetic blockade of the C2 root and ganglion.

The results suggest that microsurgical decompression of the C2 root and ganglion has some utility in treating CH. The accepted diagnostic criteria and success of anesthetic blockade of C2 should identify the subset of patients with CH predominantly caused by C2 root or ganglion effect at this level, which may favor surgical treatment.