Interventional Options for Refractory Migraines and Cervicogenic Headaches

Migraines constitute a complex disorder with a strong genetic component, characterized by episodes of moderate-to-severe headaches that may unfold over hours to days. The presentation is most often unilateral and generally associated with nausea and increased sensitivity to light and sound. Migraines are a highly prevalent condition, affecting 12% of the population, up to 17% of women, and 6% of men each year. Cervicogenic headaches are chronic and recurrent headaches that present as unilateral pain starting in the neck, accompanied by reduced range of motion. Prevalence of cervicogenic headaches among patients with headaches is 1% to 4%. These headaches manifest as referred pain arising from irritation caused by cervical structures innervated by C1-3 spinal nerves. Physical therapy is considered the first line of treatment. Spinal manipulative therapy and therapeutic exercise regimens are effective in treating headache. Some forms of headaches remain intractable to conservative therapies, for instance, due to resistance to common regimens, intolerance to pharmaceutical agents, or comorbid factors that cause interactions with their therapies. We will discuss interventional pain modalities, such as peripheral nerve stimulation, third occipital nerve block, lesser occipital nerve block, greater occipital nerve block, sphenopalatine block, radiofrequency ablation, and cervical epidural steroid injections. Various approaches to cervicogenic headaches will be reviewed, including lateral atlantoaxial joint intra-articular injections and C2 nerve root coblation.

Learning Objectives

  • Describe the symptoms associated with cervicogenic headache 
  • List the mechanisms of pain referral associated with cervicogenic headache 
  • Describe migraine and migraine subtypes 
  • Describe standard and alternative treatment options for migraine 
  • Cite the most recent findings of peripheral nerve stimulation for migraine

Additional Information

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Course summary
Available credit: 
  • 1.00 AANP Contact Hours
  • 0.20 AANP Pharmacology Contact Hours
  • 1.00 ACPE Pharmacy
  • 1.00 AMA PRA Category 1 Credit
  • 1.00 ANCC
  • 1.00 APA
Course opens: 
Course expires: 

Nebojsa Nick Knezevic, MD, PhD

Vice Chairman for Research and Education

Department of Anesthesiology and Pain Management

Advocate Illinois Masonic Medical Center

Clinical Professor of Anesthesiology and Surgery

University of Illinois College of Medicine

Chicago, IL


  • The author declares NO conflict of interest.

Available Credit

  • 1.00 AANP Contact Hours
  • 0.20 AANP Pharmacology Contact Hours
  • 1.00 ACPE Pharmacy
  • 1.00 AMA PRA Category 1 Credit
  • 1.00 ANCC
  • 1.00 APA
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