1. 2022;25;459-470The Effectiveness of Intraarticular Cervical Facet Steroid Injections in the Treatment of Cervicogenic Headache: Systematic Review and Meta-analysis
   Systematic Review
   Chane Price, MD, Teshamae Monteith, MD, John Reynolds, MLIS, Thilani Samarakoon, PhD, Brittany Mays, MD, Marisa Renee Carino Mason, BS, Michael Appeadu, MD, and Natalia Miranda-Cantellops, MD.

BACKGROUND: Cervicogenic headache (CGH) can often be difficult to treat, given the overlapping clinical features of other headaches and the varying sources of pain that patients report. While imaging is not useful in diagnosing CGH, anesthetic blockade of the atlanto-occipital joint, lateral atlantoaxial joint, or specific cervical zygapophyseal joints can be used to confirm the diagnosis. When conservative treatment measures, such as physical therapy, fail, interventional techniques, such as intraarticular steroid injections, have been shown in observational studies to provide relief in some patients.

OBJECTIVES: To determine the efficacy of intraarticular cervical facet steroid injections in the treatment of CGH.

STUDY DESIGN: Systematic review and meta-analysis.

METHODS: We conducted a comprehensive search of Ovid Medline, Embase, Cochrane Central Register of Controlled Trials , Cumulative Index to Nursing and Allied Health Literature Plus with Full Text, Scopus, and the Web of Science platform, from inception to April 2021, for studies using intraarticular cervical facet injections to treat CGH in adults aged 18 or older. Primary outcomes included mean postinjection pain scores. Outcomes were pooled using a random effects model and reported as mean differences (MD) with 95% confidence intervals (CI).

RESULTS: Three studies with a total of 64 patients met the inclusion criteria. According to data from each of the included studies, intraarticular cervical facet injections were shown to demonstrate improvement in the mean pain score from baseline to postintervention. The overall effect size—pooled MD in the Visual Analog Scale score—was 3.299 (95% CI: 2.045 to 4.552, P < 0.001). Heterogeneity (I2) was 36.11%.

LIMITATIONS: Small sample size, lack of control group, and varying pain generators and interventional technique between studies contribute to the limitations of the analysis.

CONCLUSIONS: Our findings suggest that therapeutic intraarticular cervical facet injections may be effective in the treatment of CGH. Because of the heterogeneity among the studies, these results should be interpreted with caution.

KEY WORDS: Cervicogenic headache, cervical facet pain, atlantoaxial joint, atlanto-occipital joint, steroid injection, corticosteroid injection, glucocorticoid injection, intraarticular facet injection, zygapophyseal joint, headache