Update on the role of z-joint injection and radiofrequency neurotomy for cervicogenic headache.

Cervicogenic headache is a common secondary headache that typically is referred from the upper cervical spine, that is, segments C3-C4 and rostral. Diagnostic injections to one or more of these segmental joints (including the atlanto-occipital joint, atlanto-axial joint, and C2-C3 and C3-C4 zygapophysial joints [z-joints]) frequently are used to establish the pain generator in the cervical spine that is responsible for the radiation of pain into the head. Therapeutic interventions used to alleviate pain include corticosteroid injections into the z-joint (ie, C2-C3 and C3-C4) or bony articulations (ie, C0-C1 and C2-C2), and percutaneous radiofrequency (RF) neurotomy at the C2-C3 and C3-C4 z-joints. RF neurotomy may provide the most sustained relief of headache symptoms although the relief typically is not permanent. Pulsed RF, a nondestructive modality, may also have benefit for cervicogenic headaches.