Randomised controlled trial of cervical radiofrequency lesions as a treatment for cervicogenic headache [ISRCTN07444684]

Abstract

BackgroundCervicogenic headache (CEH) is a unilateral headache localised in the neck or occipital region, projecting to the frontal and temporal regions. Since the pathogenesis of this syndrome appears to have an anatomical basis in the cervical region, several surgical procedures aimed at reducing the nociceptive input on the cervical level, have been tested. We developed a sequence of various cervical radiofrequency neurotomies (facet joint denervations eventually followed by upper dorsal root ganglion neurotomies) that proved successful in a prospective pilot trial with 15 CEH patients. To further evaluate this sequential treatment program we conducted a randomised controlled trialMethods30 patients with cervicogenic headache according to the Sjaastad diagnostic criteria, were randomised. 15 patients received a sequence of radiofrequency treatments (cervical facet joint denervation, followed by cervical dorsal root ganglion lesions when necessary), and the other 15 patients underwent local injections with steroid and anaesthetic at the greater occipital nerve, followed by transcutaneous electrical nerve stimulation (TENS) when necessary. Visual analogue scores for pain, global perceived effects scores, quality of life scores were assessed at 8, 16, 24 and 48 weeks. Patients also kept a headache diary.ResultsThere were no statistically significant differences between the two treatment groups at any time point in the trial.ConclusionWe did not find evidence that radiofrequency treatment of cervical facet joints and upper dorsal root ganglions is a better treatment than the infiltration of the greater occipital nerve, followed by TENS for patients fulfilling the clinical criteria of cervicogenic headache.

Global Rating of Change Scales: A Review of Strengths and Weaknesses and Considerations for Design

“…Overall, scales with 7 to 11 points appear to offer the best compromise between patient preference, adequate dis criminative ability, and test-retest reliability 57 . This range also corresponds to the number favored most commonly in the research literature 19,60,61 . A characteristic of rating scales is that patients tend not to respond at the extreme ends of a scale, in so-called end-aversion bias 62 .…”

“…In some cases, numerical labels include negative numbers 19 and others do not 61 . Written descriptors may be placed only on end points 7 , on all points 8 , or on not included at all 60 . The ideal scale should be balanced, with equal numbers of points on either side of a midpoint labelled unchanged.…”

Radiofrequency Ablation for Treatment of Cervicogenic Headache: Where do we stand?

“…RFN of CZJ has been shown to significantly reduce CH severity [27,28] and RFN of TON greatly improved CH which with other treatments has had a low success rate [29,30]. However, Hapspeslagh failed to find a difference between RFN and local anesthetic injection of GON in RCT study [17]. The lack of placebo in active control trials is a major limitation.…”

“…In two studies, the control group was designed with the needle placement only [7,14]. In other studies, the control group was designed with injection of anesthetics or steroid on the affected side [8,17]. It is well known that the use of a placebo control in any neural intervention is a difficult task, which adds ethical issues and difficulty with recruitment.…”

Radiofrequency Treatments for Neuropathic Pain: Review and New Approaches

“…A trial by Haspeslagh et al (Haspeslagh et al, 2006) included 30 patients with cervicogenic headache. Patients were randomized to 2 groups.…”