Successful Treatment of Occipital Radiating Headache Using Pulsed Radiofrequency Therapy

Rheumatoid arthritis (RA) is a chronic inflammatory disease involving multiple joints. The cervical spine is often affected, and cases involving atlantoaxial joint can lead to instability. Anterior atlantoaxial subluxation in RA patients can lead to posterior neck pain or occipital headache because of compression of the C2 ganglion or nerve. Here, we report the successful treatment of a RA patient with occipital radiating headache using pulsed radiofrequency therapy at the C2 dorsal root ganglion.

Manifestações otoneurológicas tardia da malformação de Chiari I / Late otoneurologic manifestations of Chiari I malformation

INTRODUÇÃO: A malformação de Chiari (MAC) pertence a um grupo de anomalias que envolvem as estruturas da junção crâniocerebelomedular. O tipo I (MAC I) é caracterizado pela descida das tonsilas cerebelares e da porção medial do lobo inferior do cerebelo pelo canal cervical. Na literatura, têm sido descritas manifestações motoras, sensoriais e autonômicas (5). É encontrada com mais frequência em mulheres. Sua prevalência é difícil de definir, pois existem muitos casos assintomáticos, o que torna escassa a informação epidemiológica (3). OBJETIVO: O objetivo do trabalho foi relatar um caso de malformação de Chiari tipo I em uma paciente de 66 anos. RELATO DE CASO: Os autores relatam um caso de malformação de Chiari tipo I, em paciente de 66 anos, com sintomas de zumbido, hipoacusia e cefaleia occipital. COMENTÁRIOS FINAIS: A hipótese diagnóstica de Chiari tipo I deve ser embasada nas queixas do paciente, no exame clínico e de imagens, sendo a prevalência desta enfermidade de difícil definição, podendo haver diagnóstico em raras faixas etárias.

INTRODUCTION: Chiari malformation (CM) belongs to an anomaly group comprised of the structures in the cranial-cerebellarmedullary junctions. Type I (CM I) is characterized by the descent of the cerebellar tonsils and the medial portion of the lower cerebellar lobe through the cervical spinal canal. In literature, motor, sensorial and autonomous manifestations have been described. It is mostly found in women. Its prevalence is hard to determine, since there are many asymptomatic cases, hence, making the epidemiologic information scarce. OBJECTIVE: The objective of this work was to report a Chiari I malformation case in a 66-year-old female patient. CASE REPORT: Authors report a Chiari I malformation case in a 66-year-old female patient, showing tinnitus, hearing loss and occipital headache symptoms. FINAL COMMENTS: Chiari I's diagnostic hypothesis must be based on the patient's complaints, clinical and image examinations, and since the prevalence of this disease is difficult to determine, there can be diagnoses in rare age groups.

Ultrasound-guided greater occipital nerve block for patients with occipital headache and short term follow up / 대한마취과학회지

BACKGROUND: The greater occipital nerve (GON) block has been frequently used for different types of headache, but performed with rough estimates of anatomic landmarks. Our study presents the values of the anatomic parameters and estimates the effectiveness of the ultrasound-guided GON blockade. METHODS: The GON was detected using ultrasound technique and distance from external occipital protuberance (EOP) to GON, from GON to occipital artery and depth from skin to GON was measured in volunteers. Patients with occipital headache were divided into two groups (ultrasound-guided block: group S, conventional blind block: group B) and GON block was performed. The same parameters were measured on group S and VAS scores were assessed at pretreatment, 1 week and 4 weeks after treatment on both groups. RESULTS: The GON had distance of 23.1 +/- 3.4 mm (right) and 20.5 +/- 2.8 mm (left) from EOP to GON. Its depth below the skin was 6.8 +/- 1.5 mm (right) and 7.0 +/- 1.3 mm (left). The distance from GON to occipital artery was 1.5 +/- 0.6 mm (right) and 1.2 +/- 0.6 mm (left) in volunteers. Initial VAS score of group S and group B patients were 6.4 +/- 0.2 and 6.5 +/- 0.2. VAS score of 4 weeks after injection were 2.3 +/- 0.2 on group S and 3.8 +/- 0.3 on group B (P = 0.0003). CONCLUSIONS: The parameters measured in this study should be useful for GON block and ultrasound-guided blockade is likely to be a more effective technique than blind blockade in occipital headache treatment.