Rationale: For some patients with cervicogenic headache or occipital neuralgia, conservative medical treatments, including oral analgesics and physical therapy, may be sufficient to relieve pain. However, a population of patients with refractory pain may require more invasive treatments, including injection therapy or surgical interventions.

Technology Description: Local injection with analgesic medications or botulinum toxin A (BTX-A) may be used to provide pain relief in patients with conditions, including cervicogenic headache and occipital neuralgia. For these conditions, injections are provided in the area of the greater or lesser occipital nerve or along tender points in the cervical muscles.

Controversy: Although there is evidence that injection therapy can provide pain relief, the duration of relief may be brief, and injections may need to be administered every few weeks or months to sustain pain relief. Regarding safety, BTX-A carries a black box warning detailing the risk of distant spread of toxin outside the area of injection. This can cause symptoms consistent with the effects of botulinum toxin exposure, including difficulties with swallowing and breathing, which can be fatal.

Key Questions:

  • Is injection therapy effective in treating occipital neuralgia or cervicogenic headache?
  • How does injection therapy compare with alternative treatments for occipital neuralgia or cervicogenic headache?
  • Is injection therapy safe?
  • Have definitive patient selection criteria been identified for injection therapy?

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