Frontiers in Neurology (Mar 2025)
Clinical features, risk factors, and a nomogram for predicting refractory cervicogenic headache: a retrospective multivariate analysis
Abstract
IntroductionGiven the intricate nature and varied symptoms of cervicogenic headache, its treatment can be challenging, potentially leading to refractory cervicogenic headache. We aimed to identify risk factors that could help predict the development of refractory cervicogenic headache in patients with cervicogenic headache.MethodsThis is a retrospective cohort study of patients diagnosed with cervicogenic headache between January 1, 2022 and March 1, 2024 who underwent greater occipital nerve block. Data were collected by reviewing patients’ medical records and pain questionnaires. Covariates were selected using univariate and multivariate logistic regression analyses. A predictive nomogram model was developed to predict the unresponsiveness of the greater occipital nerves to anesthetic blockade.ResultsOf the 82 patients studied, 46 experienced relief from headache following greater occipital nerve blocks, whereas 36 did not. In a multivariate analysis of patients with refractory cervicogenic headache, factors such as C2–C3 sensory loss [odds ratio (OR) = 13.10, 95% confidence interval (CI): 1.45–118.54], bilateral headache (OR = 7.99, 95% CI: 1.36–47.07), having two or more types of pain sources (OR = 5.51, 95% CI: 1.01–30.16), and limited cervical range of motion (>1) (OR = 13.05, 95% CI: 2.28–74.59) were identified as major prognostic indicators of unresponsiveness to greater occipital nerve blocks in cases of large occipital and cervical spine-related factors.ConclusionPatients with severely limited cervical spine mobility, bilateral headaches, and C2–C3 sensory loss may not respond well to greater and lesser occipital nerve block therapy. Pain originating from multiple sources is typically associated with less favorable outcomes.
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