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Home › Presentations › Clinical Research Posters › The Enormous Frequency of Misdiagnosis of Migraine vs. Cervicogenic Headaches Based on ICHD-III Diagnostic Criteria, and a Gigantic Opportunity to Offer Interventional Treatment for Intractable Medication Unresponsive Chronic Headaches
Clinical Research Poster
C10
Alma Mater

The Enormous Frequency of Misdiagnosis of Migraine vs. Cervicogenic Headaches Based on ICHD-III Diagnostic Criteria, and a Gigantic Opportunity to Offer Interventional Treatment for Intractable Medication Unresponsive Chronic Headaches
Author/Presenter: Benjamin Taimoorazy
Co-Author(s): None

It is proposed that migraine is the second most common form of primary headache disorders,. Trigeminovascular activation and the connections with the autonomic, oculo-vestibular complex and trigeminal nucleus caudalis results in the classic signs and symptoms of migraine. Cervicogenic headaches are a frequently overlooked cause of secondary headaches. The upper cervical joints, ligaments and musculature send their afferent input to the same spinal cord segments as the trigeminal nucleus caudalis. Therefore in the presence of upper cervical spine pathology or even in patients suffering from migraines, this high afferent input may either trigger increased activity or may reduce the activation threshold of the trigemino-cervical complex, resulting in classic signs and symptoms of migraines. Any procedure that may reduce this afferent traffic into the upper cervical spinal cord, may reduce noise levels in these pathways and may interrupt this cascade of events resulting in reduced headache frequency or severity. Our retrospective study reveals that of the 132 referred patients diagnosed as intractable medication unresponsive migraine by at least one neurologist, 72 of them (54.55%) met all of the ICHD-III diagnostic criteria of cervicogenic headaches mostly due to cervical facet joint etiology. This was confirmed by more than 80% pain relief with double diagnostic TON, C3, C4, and C5 local anesthetic medial branch nerve blocks performed on the same side of the headaches or bilaterally if indicated, followed by thermal Radiofrequency ablation of the corresponding nerves resulting in more than 80% reduction in headache frequency and severity for 14.71 months. This study underscores the overlapping signs and symptoms of migraine with secondary headaches especially of cervicogenic nature.

Author/Presenter Bio: Clinical instructor of surgery, Illinois Interventional pain management anesthesiologist Diplomate American Board of Anesthesiology, American Board of Pain Medicine, American Academy of Pain Management. Diplomate Headache Medicine by the United Council for Neurologic Subspecialties Fellow of the American Headache Society