upper cervical pain is a relatively common condition in adults and is a common cause of cervicogenic headaches
there is usually focal tenderness and possibly trigger points and there may be worsening of the pain on ROM testing of the cervical spine
they may cause referred pain through involvement of:
greater occipital nerve
lesser occipital nerve
and rarely, via the trigeminal nerve
C1-3 rorsal rami converge with trigeminal afferents via trigemino-cervical nucleus and may cause referred pain to maxillary V2 pre-auricular region
the cervicogenic headaches may be associated with blurred vision, nausea, tinnitus
atlanto-occipital and atlanto-axial arthropathies are generally clinical diagnoses as radiologic investigations including MRI are usually non-diagnostic but may be indicated to exclude other pathologies
management of these is generally conservative with:
unilateral neck pain occurring with the slightest head rotation which may be markedly reduced
a rotational head tilt deformity may be present and is usually associated with either or both:
collapse of the C1 lateral mass
subluxation of C1-2 facet joint (lateral shift of C1 lateral mass)
diagnosis can be made on a standard transoral atlas view or CT scan, showing the narrowing of the C1–C2 joint space
origin of pain was confirmed by diagnostic C1–C2 facet blocks
those with unresponsive severe pain may have excellent short and long term pain relief from C1–C2 transarticular screw fixation and Gallie type fusion 2)