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1/2. Long-term relief of posttraumatic headache by sphenopalatine ganglion pulsed radiofrequency lesioning: a case report.

    Posttraumatic headache is a common and disabling pain syndrome in patients who sustain a head injury. Unfortunately, conventional treatments may fail or cause intolerable side effects. Because chronic headache may be mediated by central and peripheral neural processes, these structures may be therapeutic targets. One target, the sphenopalatine ganglion (SPG), is implicated in several headache disorders and has been lesioned for headache relief. Because of the risks of neurolytic procedures, nonablative procedures that provide pain relief would be useful. We present a case wherein a man in his late twenties with posttraumatic headache obtained more than 17 months of relief with SPG pulsed-mode radiofrequency lesioning. SPG pulsed-mode radiofrequency is a nonablative, neural lesioning method that may be useful in the treatment of posttraumatic headache.
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2/2. Local anesthetic blocks of the second cervical ganglion: a technique with application in occipital headache.

    Dissections of five human adult cadavers revealed that the C2 spinal ganglion bears a constant relationship to the dorsal aspect of the lateral atlanto-axial joint. Radiologically, the ganglion lies extradurally opposite the midpoint of the silhouette of the lateral atlanto-axial joint space. needles can be introduced onto this target point using fluoroscopic control and used to perform selective local anesthetic blocks of the C2 spinal nerve. This technique is applicable in cases where it is difficult to decide on clinical grounds whether occipital headaches are due to an upper cervical abnormality or are a symptom of tension headache or common migraine. In particular the technique anesthetizes the otherwise inaccessible articular branches of the median and lateral atlanto-axial joints which may be an occult source of headache.
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