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ORIGINAL RESEARCH article
Front. Neurol.
Sec. Headache and Neurogenic Pain
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1531180
Clinical Features, Risk Factors, and a Nomogram for Predicting Refractory Cervicogenic Headache: A Retrospective Multivariate Analysis
Provisionally accepted
Jiawei Li 1
Baishan Wu 2*
Xiaochen Wang 3* Lijuan Zhao 1 Jie Cui 1 Jing Liu 1
Kaikai Guo 3 Xiaoyu Zhang 1 Juan Liu 4- 1 Beijing HuaSheng Rehabilitation Hospital, Beijing, China
- 2 Xuanwu Hospital, Capital Medical University, Beijing, China
- 3 The First Medical Center of PLA General Hospital, Beijing, China
- 4 Chengdu BOE Hospital, Chengdu, China
Introduction: Given 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. Methods: This 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. Results: Of 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. Conclusion: Patients 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.
Keywords: nomogram, Cervicogenic Headache, refractory cervicogenic headache, multivariate analysis, Risk factor analysis, greater occipital nerves block, Retrospective cohort study, Clinical features
Received: 20 Nov 2024; Accepted: 11 Mar 2025.
Copyright: © 2025 Li, Wu, Wang, Zhao, Cui, Liu, Guo, Zhang and Liu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Baishan Wu, Xuanwu Hospital, Capital Medical University, Beijing, China
Xiaochen Wang, The First Medical Center of PLA General Hospital, Beijing, China
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