CHARACTERISTICS OF PATIENTS SUCCESSFULLY TREATED FOR CERVICOGENIC HEADACHE BY SURGICAL DECOMPRESSION OF THE 2ND CERVICAL ROOT

We have recently reported 90% success in a series of patients undergoi ng microsurgical decompression of the second cervical (C2) nerve root and ganglion for cervicogenic headache. Review and analysis of our dat abase was carried out in order to cull factors characterizing patients amenable to this surgical treatment. Thirty-five sequential C2 decomp ressions performed on 31 patients who were pain-free or significantly improved in follow-up were evaluated retrospectively. Preoperative fac tors and intraoperative findings were analyzed for prognostic signific ance. The diagnosis of cervicogenic headache was made using establishe d criteria and success of CT-guided C2 anesthetic blockade in alleviat ing the headache. Numerous historical factors noted preoperatively inc luding 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 factor s could be established, other than the accepted diagnostic criteria an d successful anesthetic blockade of the C2 root and ganglion. These fa ctors should identify the subset of patients with cervicogenic headach e predominantly due to C2 root or ganglion effect and thus may favor a surgical treatment.