Cervicogenic headache: long-term prognosis after neck surgery.

Objectives: To evaluate the postoperative fate of chronic, hard-to-treat and partly suicidal cervicogenic headache (CEH) patients (n = 32), diagnosed according to the CHISG criteria and treated with a decompression/stabilization operation in the cervical spine: the Smith/Robinson operation.
Methods: The cervical levels of affection, singled out by magnetic resonance, anaesthetic blockades and X-ray examinations were mainly at the C4-5, C5-6, C6-7 levels; one or two discs were removed. The study was prospective and controlled.
Results: During the 1- to 3-month-long postoperative period of collar-wearing, there generally was pain freedom. The mean time of follow-up was 19.8 months: pain recurrence, known to the authors, appeared after 1-58 months (n = 12). The mean time of improvement was: 14.8 months (range 1-58 months). Five patients stayed well > or =3 years. This is certainly a minimum figure. The patients ultimately were lost to follow-up.
Conclusions: For the time being, this operation should preferably be used in selected, chronic, severely afflicted, preferably elderly CEH patients, when other therapeutic approaches are exhausted.