When to Refer Patients With Cervicogenic Headache for an Occipital Nerve Corticosteroid Injection: A Multiple-Case Series

Abstract

Objectives To evaluate the impact of physical therapist assessment in patients with cervicogenic headache (CGH) to identify who may benefit from occipital nerve corticosteroid injections (ONCIs). Design Retrospective multiple-case series. Methods Based on the physical therapist assessment, patients with C2 nerve root involvement were referred to a neurologist for ONCI. Median pain intensity per episode of CGH was measured with a numeric pain-rating scale at baseline, after ONCI, and at 3 weeks. Results Ten of the 22 patients were referred to the neurologist to receive ONCIs (mean ± SD, 2.1 ± 1.0 injections). Median headache intensity per episode was reported to be 8/10 (interquartile range [IQR], 8-10) at baseline, 6/10 (IQR, 3-6.25) immediately postintervention, and 5/10 (IQR, 2.25-6) at the 3-week follow-up. Conclusion Identification of patients who had CGH from the C2 nerve root and were referred for 1 or more ONCIs by the physical therapist may be associated with a significant pain reduction. JOSPT Cases 2021;1(3):135–142. doi:10.2519/josptcases.2021.10303