Third occipital headache: A prevalence study

University of Newcastle, Spine Research Unit, Faculty of Medicine, Callaghan, NSW, Australia.
Journal of Neurology Neurosurgery & Psychiatry (Impact Factor: 6.81). 10/1994; 57(10):1187-90. DOI: 10.1136/jnnp.57.10.1187
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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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    • "Lord et al. (1994) stated that the prevalence of TON headache among patients in whom headache is the predominant complaint after whiplash was as high as 53%. This suggests that third occipital neuralgia is the most common cause of headache in patients who experienced whiplash (Lord et al., 1994). Various therapies for the treatment of third occipital neuralgia exist giving clinicians a variety of nonsurgical options to treat their patients (Ashkenazi and Levin, 2004; Tobin and Flitman, 2009). "
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    ABSTRACT: Occipital neuralgia is a debilitating disorder first described in 1821 as recurrent headaches localized in the occipital region. Other symptoms that have been associated with this condition include paroxysmal burning and aching pain in the distribution of the greater, lesser, or third occipital nerves. Several etiologies have been identified in the cause of occipital neuralgia and include, but are not limited to, trauma, fibrositis, myositis, fracture of the atlas, and compression of the C-2 nerve root, C1-2 arthrosis syndrome, atlantoaxial lateral mass osteoarthritis, hypertrophic cervical pachymeningitis, cervical cord tumor, Chiari malformation, and neurosyphilis. The management of occipital neuralgia can include conservative approaches and/or surgical interventions. Occipital neuralgia is a multifactorial problem where multiple anatomic areas/structures may be involved with this pathology. A review of these etiologies may provide guidance in better understanding occipital neuralgia. Clin. Anat., 2014. © 2014 Wiley Periodicals, Inc.
    Clinical Anatomy 09/2014; 28(1):101-108. DOI:10.1002/ca.22468 · 1.33 Impact Factor
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    • "These signs were originally thought to reflect zygapophyseal joint pain [18] although recent evidence argues against this [68]. The prevalence of this finding is higher than the estimated prevalence of zygapophyseal joint pain of 50% in patients with chronic neck pain or headache [69-71]. This difference may be due to the mix of acute and chronic patients in the present cohort or may reflect the possibility that segmental pain provocation signs may provoke pain arising from other structures in addition to those related to the zygapophyseal joints. "
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    ABSTRACT: Neck pain (NP) is a common cause of disability. Accurate and efficacious methods of diagnosis and treatment have been elusive. A diagnosis-based clinical decision guide (DBCDG; previously referred to as a diagnosis-based clinical decision rule) has been proposed which attempts to provide the clinician with a systematic, evidence-based guide in applying the biopsychosocial model of care. The approach is based on three questions of diagnosis. The purpose of this study is to present the prevalence of findings using the DBCDG in consecutive patients with NP. Demographic, diagnostic and baseline outcome measure data were gathered on a cohort of NP patients examined by one of three examiners trained in the application of the DBCDG. Data were gathered on 95 patients. Signs of visceral disease or potentially serious illness were found in 1%. Centralization signs were found in 27%, segmental pain provocation signs were found in 69% and radicular signs were found in 19%. Clinically relevant myofascial signs were found in 22%. Dynamic instability was found in 40%, oculomotor dysfunction in 11.6%, fear beliefs in 31.6%, central pain hypersensitivity in 4%, passive coping in 5% and depression in 2%. The DBCDG can be applied in a busy private practice environment. Further studies are needed to investigate clinically relevant means to identify central pain hypersensitivity, oculomotor dysfunction, poor coping and depression, correlations and patterns among the diagnostic components of the DBCDG as well as inter-examiner reliability, validity and efficacy of treatment based on the DBCDG.
    Chiropractic and Manual Therapies 08/2011; 19(1):19. DOI:10.1186/2045-709X-19-19
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    • "Several studies have demonstrated that the C2-3 zygapophysial joint can be the source of pain in many patients with headache [35] [36]. Anesthetizing the joint completely abolishes the headache in these patients. "
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    ABSTRACT: Neck pain should not, and must not, be confused with cervical radicular pain. Equating the two conditions, or confusing them, results in misdiagnosis, inappropriate investigations, and inappropriate treatment that is destined to fail. So critical is the difference that pedagogically it is unwise to include the two topics in the same book, let alone the same article. However, traditions and expectations are hard to break. In deference to habit, this article addresses both entities, but does so by underplaying cervical radicular pain so as to retain the emphasis on neck pain.
    Physical Medicine and Rehabilitation Clinics of North America 08/2011; 22(3):367-82, vii. DOI:10.1016/j.pmr.2011.03.008 · 0.93 Impact Factor
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