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. 1994 Oct;57(10):1187–1190. doi: 10.1136/jnnp.57.10.1187

Third occipital nerve headache: a prevalence study.

S M Lord 1, L Barnsley 1, B J Wallis 1, N Bogduk 1
PMCID: PMC485484  PMID: 7931379

Abstract

A consecutive series of 100 patients was studied to determine the prevalence of third occipital nerve headache in patients with chronic neck pain (> three months in duration) after whiplash. Seventy one patients complained of headache associated with their neck pain. Headache was the dominant complaint of 40 patients, but was only a secondary problem for the other 31. Each patient with headache underwent double blind, controlled diagnostic blocks of the third occipital nerve. On two separate occasions the nerve was blocked with either lignocaine or bupivacaine, in random order. The diagnosis of third occipital nerve headache was made only if both blocks completely relieved the patient's upper neck pain and headache and the relief lasted longer with bupivacaine. The prevalence of third occipital nerve headache among all 100 whiplash patients was 27% (95% confidence interval (95% CI) 18-36%) and among those with dominant headache the prevalence was as high as 53% (95% CI 37-68%). There were no distinguishing features on history or examination that enabled a definitive diagnosis to be made before the nerve blocks. Those patients with a positive diagnosis, however, were significantly more likely to be tender over the C2-3 zygapophysial joint (p = 0.01). Third occipital nerve headache is a common condition in patients with chronic neck pain and headache after whiplash. Third occipital nerve blocks are essential to make this diagnosis.

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Selected References

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  1. Abel M. S. Occult traumatic lesions of the cervical vertebrae. CRC Crit Rev Clin Radiol Nucl Med. 1975 Sep;6(4):469–553. [PubMed] [Google Scholar]
  2. Balla J. I. The late whiplash syndrome. Aust N Z J Surg. 1980 Dec;50(6):610–614. doi: 10.1111/j.1445-2197.1980.tb04207.x. [DOI] [PubMed] [Google Scholar]
  3. Barnsley L., Bogduk N. Medial branch blocks are specific for the diagnosis of cervical zygapophyseal joint pain. Reg Anesth. 1993 Nov-Dec;18(6):343–350. [PubMed] [Google Scholar]
  4. Barnsley L., Lord S. M., Wallis B. J., Bogduk N. Lack of effect of intraarticular corticosteroids for chronic pain in the cervical zygapophyseal joints. N Engl J Med. 1994 Apr 14;330(15):1047–1050. doi: 10.1056/NEJM199404143301504. [DOI] [PubMed] [Google Scholar]
  5. Barnsley L., Lord S., Bogduk N. Comparative local anaesthetic blocks in the diagnosis of cervical zygapophysial joint pain. Pain. 1993 Oct;55(1):99–106. doi: 10.1016/0304-3959(93)90189-V. [DOI] [PubMed] [Google Scholar]
  6. Barnsley L., Lord S., Wallis B., Bogduk N. False-positive rates of cervical zygapophysial joint blocks. Clin J Pain. 1993 Jun;9(2):124–130. doi: 10.1097/00002508-199306000-00007. [DOI] [PubMed] [Google Scholar]
  7. Bogduk N., Marsland A. On the concept of third occipital headache. J Neurol Neurosurg Psychiatry. 1986 Jul;49(7):775–780. doi: 10.1136/jnnp.49.7.775. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Bogduk N. The clinical anatomy of the cervical dorsal rami. Spine (Phila Pa 1976) 1982 Jul-Aug;7(4):319–330. doi: 10.1097/00007632-198207000-00001. [DOI] [PubMed] [Google Scholar]
  9. Bovim G., Berg R., Dale L. G. Cervicogenic headache: anesthetic blockades of cervical nerves (C2-C5) and facet joint (C2/C3). Pain. 1992 Jun;49(3):315–320. doi: 10.1016/0304-3959(92)90237-6. [DOI] [PubMed] [Google Scholar]
  10. Clark C. R., Igram C. M., el-Khoury G. Y., Ehara S. Radiographic evaluation of cervical spine injuries. Spine (Phila Pa 1976) 1988 Jul;13(7):742–747. doi: 10.1097/00007632-198807000-00006. [DOI] [PubMed] [Google Scholar]
  11. Edmeads J. The cervical spine and headache. Neurology. 1988 Dec;38(12):1874–1878. doi: 10.1212/wnl.38.12.1874. [DOI] [PubMed] [Google Scholar]
  12. Ehni G., Benner B. Occipital neuralgia and the C1-2 arthrosis syndrome. J Neurosurg. 1984 Nov;61(5):961–965. doi: 10.3171/jns.1984.61.5.0961. [DOI] [PubMed] [Google Scholar]
  13. Gargan M. F., Bannister G. C. Long-term prognosis of soft-tissue injuries of the neck. J Bone Joint Surg Br. 1990 Sep;72(5):901–903. doi: 10.1302/0301-620X.72B5.2211780. [DOI] [PubMed] [Google Scholar]
  14. Jónsson H., Jr, Bring G., Rauschning W., Sahlstedt B. Hidden cervical spine injuries in traffic accident victims with skull fractures. J Spinal Disord. 1991 Sep;4(3):251–263. doi: 10.1097/00002517-199109000-00001. [DOI] [PubMed] [Google Scholar]
  15. Maimaris C., Barnes M. R., Allen M. J. 'Whiplash injuries' of the neck: a retrospective study. Injury. 1988 Nov;19(6):393–396. doi: 10.1016/0020-1383(88)90131-3. [DOI] [PubMed] [Google Scholar]
  16. McNamara R. M., O'Brien M. C., Davidheiser S. Post-traumatic neck pain: a prospective and follow-up study. Ann Emerg Med. 1988 Sep;17(9):906–911. doi: 10.1016/s0196-0644(88)80669-3. [DOI] [PubMed] [Google Scholar]
  17. Norris S. H., Watt I. The prognosis of neck injuries resulting from rear-end vehicle collisions. J Bone Joint Surg Br. 1983 Nov;65(5):608–611. doi: 10.1302/0301-620X.65B5.6643566. [DOI] [PubMed] [Google Scholar]
  18. Pennie B., Agambar L. Patterns of injury and recovery in whiplash. Injury. 1991 Jan;22(1):57–59. doi: 10.1016/0020-1383(91)90166-c. [DOI] [PubMed] [Google Scholar]
  19. Woodring J. H., Goldstein S. J. Fractures of the articular processes of the cervical spine. AJR Am J Roentgenol. 1982 Aug;139(2):341–344. doi: 10.2214/ajr.139.2.341. [DOI] [PubMed] [Google Scholar]

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