Radiofrequency treatment of cervicogenic headache

Abstract

Objectives: In the clinical management of facial pain, a possible cervical origin must be considered. A clinical exploration is therefore essential. The disorder originates in the intimate connections between the cranial portion of the spinal cord and the trigeminal system. Although solid evidence supporting the use of radiofrequency (RF) treatment is lacking, it remains one of the management options to be taken into account. The present study evaluates the efficacy of RF in application to cervicogenic headache. Study design: We present three cases of severe facial pain arising from different cervical structures. Results: In two cases the pain originated in cervical roots C2 and C3, while in the third patient the trigger point was located at the level of the atlantoaxial joint. Pulsed RF was applied for 4 minutes at the dorsal ganglion of C2 and C3 in the first two cases, and for 8 minutes at intraarticular level in the third patient. The pain gradually subsided during the first month in all cases. The first two patients reported 70% improvement after one month, 60% improvement after 6 months, and 30-50% after one year, versus baseline. The third patient reported complete pain resolution lasting approximately 5 months, after which the pain reappeared with the same intensity as before. Conclusions: Radiofrequency is a satisfactory treatment option, affording adequate analgesia, though the effects are sometimes temporary. Key words:Cervicogenic headache, pulsed radiofrequency, analgesia.

Diffusion tensor imaging of the C1-C3 dorsal root ganglia and greater occipital nerve for cervicogenic headache

“…Intraneural edema, axon swelling, myelinolysis and dilated intercellular space, and increased diffusion of water molecules result in a high ADC value [ 12 , 23 , 24 ]. The results revealed neuropathy in the DRG in CGH, which were similar with results by Bovaira et al [ 7 ] and Mehnert and Freedman [ 25 ]. We hypothesize that joint degeneration, connective tissue thickening, and fibrosis around nerves that affect the upper three DRG (not only near the C2 spinal nerve or C2 DRG) could be causes of CGH.…”

“…Intervertebral disc degeneration, as well as nerve root inflammation and compression can result in neuropathy of the upper three cervical DRG, which are recognized as an important cause of headaches in the occipital region [ 5 , 6 ]. Blocks of the GON and pulsed radiofrequency of the DRG are the most frequently used methods in the treatment of CGH [ 4 , 6 , 7 ]. However, the mechanisms of such invasive procedures are still unclear and lack objective evaluation criteria [ 7 , 8 ].…”

“…Blocks of the GON and pulsed radiofrequency of the DRG are the most frequently used methods in the treatment of CGH [ 4 , 6 , 7 ]. However, the mechanisms of such invasive procedures are still unclear and lack objective evaluation criteria [ 7 , 8 ]. The diagnostic criteria proposed by the International Headache Society (IHS) and the Cervicogenic Headache International Study Group (CHISG) are widely used for CGH with different decisions [ 2 , 3 , 9 ].…”

Bilateral Intra-Articular Radiofrequency Ablation for Cervicogenic Headache

“…In a reported case series by Bovaira et al, bilaterally targeting the DRG of C2 and C3 provided satisfactory relief of cervicogenic headache [12]. Others have applied pulsed RF to the greater occipital nerve and left atlantoaxial joint region with good results [9, 11].…”

“…The window to access the posterior capsule of the C1-2 joint may be just a few millimeters between the medial DRG and the lateral vertebral artery, using the thermal approach with a small needle and active short tip permits for a smaller lesion. We therefore caution that the approach to intra-articular RF of AA joint, whether by conventional or cooled methods, be done with cognizance of important neurovascular and anatomic structures to avoid, which will lessen the risk of complications [12, 13]. …”