Can cervicogenic headache be treated with high doses of oxycodone in conjunction with a medication-reflex preparation and/or physiotherapy? answer: Results are encouraging with oxycodone at the doses utilized. Further investigation is necessary to further define treatment protocols.
Patients with cervicogenic headache often have recurrent debilitating episodes of headache. Treatment is determined by the treating clinician but may include medications including acetaminophen, ibuprofen, or naproxen. The efficacy of analgesic medications for this condition is not clear. Lignocaine topical patches may be used for the first few weeks after onset of symptoms, but are only recommended by those clinicians familiar with their application. Steroid medications are commonly used in those patients with refractory symptoms. The prognosis of cervicogenic headache is generally good, although the frequency of attacks in individuals with cervicogenic headache is reduced.
Cervicogenic headache can be caused or worsened by the cervical spine. In contrast to other types of headache, cervicogenic headache can be triggered or precipitated by specific events.
There is a high proportion of persons who have received a CCH diagnosis and need to be appropriately treated in the United States. It remains, therefore, relevant to study the demographics of persons who have received a CCH diagnosis and to explore factors contributing to these disorders being unrecognized with their initial clinical presentation.
Cervical dicraffery and/or degeneration of the transverse ligaments of the spine are the most important causes of a chronic headache. The cervical spine is the site of origin of much of migraine and tension-type headache. Cervical pain is also a common presenting symptom of C-1 spondylosis.
There have been several clinical trials involving the use of steroids in the treatment of cervical root compression with positive results. However, the evidence to support the use of steroids in patients with cervical root compression remains undefined. No clinical trials have been conducted using dexamethasone therapy. It is our intention that this study be the first of its kind to test the use of systemic therapy against conservative treatment in patients with cervicogenic headache.
Dexamethasone is safe in a subset of people with cervicogenic headache who receive a non-opioid treatment (e.g., NSAIDs or gatifloxacin, [<ref>Bruyère et al. 2006; Am J Phys Med Rehabil 82: 1414-1418; Haldeman et al. 2006; Arch Phys Med Rehabil 86: 714-715; Haldeman et al. 2005; Arch Phys Med Rehabil 84: 713-714; Haldeman et al. 2003; Am J Phys Med Rehabil 80: 1331-1336; <ref>NINDS-RCT2005013829</ref> ).
Treatment for cervicogenic headache has not changed in the past 20 years. Cervicogenic headache is uncommon but can be devastating, and so treatment is certainly needed. There is still no evidence-based management. Randomized controlled trials to determine the effectiveness of new treatments are urgently needed.
Patients with a recent neck radiography report a higher prevalence of cervicogenic headache than patients without cervical radiographs. Younger females have a significantly higher prevalence of cervicogenic headache than older females. Clinical trials examining the effect of interventions on cervicogenic headache may include patients with or without a recent neck radiography report.
We conclude that a diagnosis of cervicogenic headache was not more likely in families with a history of cervicogenic headache but was more likely in families with a history that included other headaches.
Most common side effects include hypotension, transient hypotension that spontaneously disappears by day 3. Hypotension is often due to dexamethasone-induced activation of adrenergic receptors due to the depletion of glucocorticoids. Dexamethasone was significantly associated with hypertension as well as transient hypotension on day 1, 2, and 3. Hypo-osmotic dehydration, a rare side effect from dexamethasone-induced depletion of osmotic agents, is a potential long-term complication.