An atlanto-axial injection goes into the C1–C2 joint at the very top of the neck. It is for headache that is genuinely coming from that joint. It is performed under fluoroscopy (live X-ray), never blind.
Can the C1–C2 joint cause headaches?
The atlanto-axial joint is the joint between the first and second cervical vertebrae (neck bones) — the joint that lets you shake your head “no”. It carries far more rotation than any other joint in the neck. It is a recognized source of cervicogenic headache. Pain referred from there is felt in the back of the head and behind the ear, usually on one side.
It is also frequently missed. That is because it sits above the levels that most cervical imaging and most injections address.
Why is a C1–C2 injection never done blind?
The vertebral artery and the C2 nerve root sit right next to the injection target. The spinal cord is a few millimeters away. In interventional pain practice, this is one of the injections where image guidance is not a refinement — it is the difference between a safe procedure and an unacceptable one.
It is performed under fluoroscopy with contrast confirmation. The needle position is verified on X-ray images. Contrast is injected first to confirm the medication will go where it is intended and not into a vessel.
How does the injection show whether C1–C2 is the cause?
As with other blocks here, the first injection answers a question. If anesthetizing (numbing) the C1–C2 joint abolishes your headache, that joint is the generator. Then longer-term options become reasonable. If it does not, the source is elsewhere and we look again.
Booking online shows our scheduled openings. Call or text for hours that are not listed. Please contact us before coming in rather than arriving unannounced — we need to know what is happening to have the right treatment ready.
A note on coverage, and on timing. Same-day treatment and prior authorization do not run on the same clock. Many insurers take days to weeks to decide. Some acute headache treatments are not covered at all. Your headache will not wait for that process.
We will verify your benefits. Where a treatment needs prior authorization, we will attempt to obtain it. An authorization confirms that a service meets criteria for review — it is not a guarantee of payment. No clinic can make that promise on your insurer’s behalf. Sometimes a treatment is unlikely to be covered, or it cannot be certified in time to treat you today. If so, we will tell you before we treat rather than after, so the decision is yours. Payment is due at the time of service.
Frequently asked questions
What is an atlanto-axial joint injection?
It is an injection into the C1–C2 joint at the very top of the neck. This is the joint between the first and second vertebrae that lets you shake your head “no”. It is used for headache that is genuinely coming from that joint. It is always performed under fluoroscopy with contrast confirmation, never blind.
Where do you feel pain from the C1–C2 joint?
Pain referred from the atlanto-axial joint is felt in the back of the head and behind the ear, usually on one side. It is a recognized source of cervicogenic headache. It is frequently missed because the joint sits above the levels that most cervical imaging and most injections address.
Is a C1–C2 injection safe?
Image guidance is what makes it safe, and it is the only way we do it. The vertebral artery and the C2 nerve root sit right next to the target. The spinal cord is a few millimeters away. The needle position is checked on fluoroscopy. Contrast goes in first to confirm the medication will not enter a vessel.
What happens if the injection does not stop my headache?
Then the source is elsewhere, and we look again. The first injection is diagnostic: it answers a question. If numbing the C1–C2 joint abolishes your headache, that joint is the generator. Then longer-term options become reasonable. If it does not, the joint has been ruled out and the search moves on.