Atlantodental Osteoarthritis

Definition

Headache due to atlantodental osteoarthritis falls under the cervicogenic headache group and is a clinically defined headache syndrome originating in the cervical nociceptors.

Aetiology

The cause of cervicogenic headache within the framework of atlantodental osteoarthritis is sclerosis of the atlantodental joint. In rare cases, this sclerosis occurs after a serious throat infection, during which the inflammation spreads to this joint (Grisel's Syndrome).

Signs and symptoms

Headache irradiating from the neck is the reason patients seek help. During establishing the medical history, general questions should be asked, such how long the complaints last, frequency, localisation of the headache, provoking factors, symptoms of migraine, traumas, medication, previously applied treatment, medical family history, etc.

The headache is frequently located in the occipital region and can occur both nilaterally and bilaterally. The headache may manifest as an attack, ranging in duration from several hours to several days. The duration of an attack is unpredictable.

Complaints such as motion restriction of the neck and stimulation of the neck and/or headache in rotation and static load are frequently seen.

Diagnostics

Physical Examination

Physical examination of the cervical spine comprises a number of elements:

  1. Motion analysis of the cervical spine: passive forward flexion, backward flexion, lateral flexion and rotation has to be judged with respect to motion restriction.
  2. Segmental palpation of the upper, mid and lower cervical facet joints.
  3. Judgement of the next  'pain pressure point':

a. greater occipital nerve (occipital temporal portion of the skull)
b. lesser occipital nerve (skull insertion of the sternocleidomastoid muscle)
c. third cervical nerve root (facet joint C2/C3)
d. edges of the trapezius muscle

A remarkable finding is the serious rotation restriction both in normal passive rotation and passive rotation in the forward flexion position of the cervical spine. The last-mentioned is frequently completely absent.

Additional Somatic Diagnostics

  • CT scan of the craniocervical junction (thin slices) can show atlantodental osteoarthritis. In the case of 'red flags', always perform an MRI scan.

Additional Psycho-cognitive Diagnostics

  • RAND-36 (quality of life)
  • VAS-Pain (maximal, minimal, actual, average/week)
  • PCS (catastrophising)
  • HADS (fear and depression)

Multidisciplinary Treatment

Whether or not somatic treatment is indicated is based on the pain diagnosis.  Based on the findings of the pain questionnaires, additional diagnostics and/or multidisciplinary treatment comprising various non-somatic treatments may be necessary.

Non-somatic Treatment

Somatic Treatment

Pharmacological treatment:

Other Treatments

Interventional Pain Treatment

Up until now, no generally accepted interventional pain treatment for cervicogenic headache is available. This is due to the fact that the aetiology of cervicogenic headache is unknown. Therefore, many treatments are symptomatic in character.