Bilateral Intra-Articular Radiofrequency Ablation for Cervicogenic Headache

Abstract

Introduction. Cervicogenic headache is characterized by unilateral neck or face pain referred from various structures such as the cervical joints and intervertebral disks. A recent study of patients with cervical pain showed significant pain relief after cervical medial branch neurotomy but excluded patients with C1-2 joint pain. It remains unclear whether targeting this joint has potential for symptomatic relief. To address this issue, we present a case report of C1-2 joint ablation with positive outcomes. Case Presentation. A 27-year-old female presented with worsening cervicogenic headache. Her pain was 9/10 by visual analog scale (VAS) and described as cramping and aching. Pain was localized suboccipitally with radiation to her jaw and posterior neck, worse on the right. Associated symptoms included clicking of her temporomandibular joint, neck stiffness, bilateral headaches with periorbital pain, numbness, and tingling. History, physical exam, and diagnostic studies indicated localization to the C1-2 joint with 80% decrease in pain after C1-2 diagnostic blocks. She underwent bilateral intra-articular radiofrequency ablation of the C1-C2 joint. Follow-up at 2, 4, 8, and 12 weeks showed improved function and pain relief with peak results at 12 weeks. Conclusion. Clinicians may consider C1-C2 joint ablation as a viable long-term treatment option for cervicogenic headaches.

Safety and Efficacy of Radiofrequency Ablation and Epidural Steroid Injection for Management of Cervicogenic Headaches and Neck Pain: Meta-Analysis and Literature Review

“…Studies have demonstrated the effectiveness of RFA in treating some pain conditions [9,13]. It is believed that interrupting these nerves' normal activity for a small period of time with an anesthetic block or a semi-permanent period with RF lesioning causes Wallerian degeneration of the afferent nerve fibers, which frequently reduces this referred pain [5,12,13]. However, according to this study and others, pain alleviation is typically just transient and only lasts till the time of nerve regeneration or healing.…”

“…The most extensively studied interventional therapy for CHA is radiofrequency ablation (RFA) of the cervical medial branch with third occipital nerve (TON) neurotomy [12]. RFA of the cervical medial branch nerve and TON is used to destroy the afferent nerve supply, which is thought to be the main source of discomfort for the CHA.…”

“…However, according to this study and others, pain alleviation is typically just transient and only lasts till the time of nerve regeneration or healing. While RFA alleviates the crippling pain, it does not address the headache's underlying causes, which are frequently never fully determined [12,13].…”

The Chinese Association for the Study of Pain (CASP): Expert Consensus on the Cervicogenic Headache

“…Recent studies have indicated that head and face pain in CEH originate from disorders of the upper cervical nerves (C1–C3) [8]. Indeed, lesions in the atlantooccipital joint, atlantoaxial joint, C2-C3 zygapophyseal joint, and intervertebral disk can all cause occipital pain [9–11].…”

Electroacupuncture for treatment of cervicogenic headache: A meta-analysis

“…Cervicogenic headache (CHE) is a chronic headache syndrome, caused by pathological changes in the bones and/or neck soft tissues, and always presents as pain and tenderness in the neck, resulting in stiffness and limitations of activity [1]. The pain could be aggravated as the disease progressing, and quality of life is seriously affected; nevertheless, the etiology and pathophysiology have been debated intensively.…”