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Background and Aims Cervicogenic headache refers to the pain that originates from the cervical spine or nerve roots. While numerous treatments have been proposed for cervicogenic headache, only a limited number of them have undergone testing, and even fewer have demonstrated proven success. The ultrasound (US) guided suboccipital block-2 (SOB-2) is a recently defined technique for the treatment of cervicogenic headache.

Methods Following a comprehensive clinical evaluation, all nine patients were diagnosed with cervicogenic headache. Their diagnoses were established by the diagnostic criteria for cervicogenic headache as outlined in the International Classification of Headache Disorders.In US-guided SOB-2; injection was performed into the fascial plane deep to the inferior oblique capitis muscle, targeting the C2 dorsal root ganglion, C2 nerve root, and the atlanto-occipital joint capsule (figure 1). Patients with occipital neuralgia for >6 weeks, have an ipsilateral arthrosis of the lateral C1–C2 facet joint on CT and refractory to conservative treatment had undergone US-guided SOB-2. Written informed consent for the procedure and future publishing was obtained from patients.

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Abstract OP016 Figure 1

Illustration of suboccipital block-2

Results Patiens had experienced improvement in NRS score for 3 months (table 1). Repeated blocks were performed at month 1 and 2 in two and one patients, respectively. The number of headache-day per month was decreased. Among the patients, three individuals experienced paresthesia in the occipital distribution, characterized by numbness and tingling. A majority of the patients were able to reduce or completely stop using oral analgesics.

Conclusions US-guided SOB-2 is a safe and efficacious procedure for the treatment of cervicogenic headache in patients with ipsilateral symptomatology.