Options for cervical facet based Tension headaches?

[KimSb]

I've been suffering from chronic unrelenting cervicogenic "Tension Headaches." for several years. Symptoms are pressure, tightness and intoxicated/hangover-like symptoms. Feels like I'm wearing a helmet that's too tight. I was diagnosed by a Neurologist at an aacdemic hospital with Cervical Facet Disease/cervicogenic headaches. He tried PT, chiro & a myriad of meds to no avail. Botox was suggested but is expensive, transient in relief, and not covered by insurer.

I had 3 lidocaine facet blocks under fluoroscopy at an academic hospital with no improvement. The 4th was helpful albeit, with transient results. Consquently, a Radio frequency ablation procedure was performed on the aforementioned 4th facet. It's been a months & I've had no improvement. MD wants to do more blocks on the other side of my cervical facet joints. He does not think the occiptital nerve is causing the symptoms but I've heard from other MDs that occiptal nerve compression can cause tension headaches.

At this point, I'm confused & not sure which direction to turn. The Radio Frequency Ablation was painful and it appears the results are hit or miss. I'm puzzled why the block worked, yet the ablation didn't. Can symptoms come from more than one Facet Joint nerve, thus ablating them all is an option? Do you have any other more benign treatment suggestions?

Thanks for your help, most appreciated.

[KimSb]

The Brain MRI was normal. The cervical MRI showed mild posterior bulging, ridging and spuring at C5-6, mild posterior bulging & spuring at C3-4 & C4-5. No disc herniation or cord impingement found. Mild degenerative changes in the mid cervical spine. Are you familiar with the occipital nerve decompression surgery?

[Prem Pillay, MD]

One option is to have a cervical epidural steroid injection under CT guidance.
Occipital nerve decompression is an option but before proceeding to this, a trial nerve block can be done to see whether there is relief of your headaches.

Cervicogenic headaches can also be treated by gentle cervical traction: either the new forms of computerized traction system or during aquatherapy as aquatraction.

Dr Prem Pillay MBBS FRCS(Canada) FACS(USA)
Senior Consultant Neurosurgeon
Director of Neuro and Spine Services
Neuro Spine and Pain Center
Singapore

[KimSb]

Can the spurring impinge on Facet Nerves & cause my symptoms?

[Prem Pillay, MD]

What did your MRIs of the brain and cervical spine show?
Did you have cervical HNPs?
Newer procedures like Low level laser therapy, and floatation therapy (aquarelax) may be of help and are quite risk free.
You may wish to consult with a neurosurgeon if you do have significant cervical HNPs.