Bilateral C1/2 synovial cysts causing cervicogenic headache

Cervical synovial cysts, while uncommon, occur frequently at the C1/2 level. However, bilateral cysts at this level have not been previously reported. We report a 77-year-old man with cervicogenic headache caused by bilateral C1/2 synovial cysts. He presented with occipital pain that was exacerbated when rotating his head to the left. Magnetic resonance imaging revealed bilateral C1/2 facet joint cysts. Dynamic cervical spine radiography showed no instability. Nonsurgical treatment with a neck brace and an analgesic was initiated. One month later, his symptoms had completely resolved and follow-up imaging demonstrated shrinkage of both cysts. Conservative management can be effective for cervical synovial cysts, even bilateral ones, when the cyst does not extend into the spinal canal and neurological symptoms are minimal. Treatment should be individualized based on patient-specific factors and imaging findings.