Treatment of hemicrania continua with radiofrequency ablation and long-term follow-up

Beams, Jennifer L; Kline, Matthew T.; Rozen, Todd D.

doi:10.1177/0333102415575726

Cited by 12 publications

(6 citation statements)

References 22 publications

(41 reference statements)

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“…These studies (excluding case series and reports) are summarized in Tables 1, 2, 3, 4, and 5. Studies involving RF treatment of the SNS primarily focused on its efficacy in CRPS (Table 1) [28][29][30][31][32][33][34][35][36], pain in the perineal region (Table 2) [37][38][39][40][41][42][43][44][45][46][47][48], headache and facial pain (Table 3) [49][50][51][52][53][54][55][56][57][58][59][60][61][62][63], and oncologic and non-oncologic abdominal pain (Table 4) [64][65][66][67][68][69][70][71]…”

Section: Methodsmentioning

confidence: 99%

Interventional Radiofrequency Treatment for the Sympathetic Nervous System: A Review Article

et al. 2021

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Section: Methodsmentioning

confidence: 99%

Interventional Radiofrequency Treatment for the Sympathetic Nervous System: A Review Article

et al. 2021

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“…During this time her ptosis did improve or resolve transiently until her pain returned. As the authors previously reported on alleviation of HC with specific nerve injection procedures, our patient underwent a sphenopalatine block with moderate success [8]. She had no improvement with supraorbital/supratrochlear blocks.…”

Section: Case Presentationsmentioning

confidence: 80%

“…The fascinating and unexpected resolution of a chronic fixed ptosis and miosis of long duration (6 months and 2 years) would suggest reversible sympathetic dysfunction from irritation of the sympathetic chain rather than permanent injury as the result of vasodilatory trauma. The presumed mechanism as to how the cervical facet radiofrequency procedure helped alleviate the ptosis is suppression of the trigeminal cervical complex at C2 with feedback suppression of the trigeminal autonomic reflex with resolution of internal carotid artery dilation and compression of the sympathetic chain [8]. In regard to how indomethacin was able to alleviate Horner’s syndrome, one would assume this was also by suppressing the trigeminal autonomic reflex.…”

Section: Discussionmentioning

confidence: 99%

Chronic persistent Horner’s syndrome in trigeminal autonomic cephalalgia subtypes and alleviation with treatment: two case reports

Rozen

Kline

2019

J Med Case Reports

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BackgroundThe trigeminal autonomic cephalalgias are a group of primary headache syndromes marked by severe head pain and associated cranial autonomic symptoms which can include a full or partial Horner’s syndrome. Rarely, the eye-related symptoms will become fixed even between headache attacks. There is minimal documentation that the Horner’s syndrome can be reversed if successful treatment of the underlying headache disorder is initiated.Case reportsTwo cases are presented of trigeminal autonomic cephalalgia subtypes with chronic persistent Horner’s syndromes that alleviated with treatment of the underlying primary headache disorder. Patient 1, an 82-year-old Caucasian woman, presented with hemicrania continua with a partial Horner’s syndrome that was present for 2 years. She was unable to take indomethacin as she was on anticoagulation. After a C2–3 diagnostic facet injection, not only did she become pain free but her ptosis completely resolved. She then underwent a radiofrequency facet neurotomy with complete alleviation of head pain and complete resolution of her ptosis. Patient 2, a 21-year-old Caucasian woman, presented with long-lasting autonomic symptoms with hemicrania syndrome and a fixed miosis and ptosis of 6 months’ duration. After achieving 2 months of pain freedom on indomethacin her Horner’s syndrome completely resolved.ConclusionA chronic fixed partial or full Horner’s syndrome can occur in trigeminal autonomic cephalalgia subtypes, but it can also be reversed in patients with treatment even after months to years of duration. This would suggest that the sympathetic dysfunction leading to the eye-related symptoms is from irritation of the sympathetic chain rather than permanent injury as the result of vasodilatory trauma after trigeminal autonomic reflex activation.

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“…Beams et al53 have demonstrated positive effects of radio-frequency ablation of the C2 ventral ramus (one case), C2 dorsal root ganglion (two cases) and SPG (one case). The response after each radiofrequency procedure was long lasting and it persisted from 1 to 2.5 years.…”

Section: Managementmentioning

confidence: 99%

Hemicrania continua: clinical review, diagnosis and management

Prakash¹,

Patel

2017

JPR

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Hemicrania continua (HC) is an indomethacin-responsive primary headache disorder which is currently classified under the heading of trigeminal autonomic cephalalgias (TACs). It is a highly misdiagnosed and underreported primary headache. The pooled mean delay of diagnosis of HC is 8.0 ± 7.2 years. It is not rare. We noted more than 1000 cases in the literature. It represents 1.7% of total headache patients attending headache or neurology clinic. Just like other TACs, it is characterized by strictly unilateral pain in the trigeminal distribution, cranial autonomic features in the same area and agitation during exacerbations/attacks. It is different from other TACs in one aspect. While all other TACs are episodic, HC patients have continuous headaches with superimposed severe exacerbations. The central feature of HC is continuous background headache. However, the patients may be worried only for superimposed exacerbations. Focusing only on exacerbations and ignoring continuous background headache are the most important factors for the misdiagnosis of HC. A large number of patients may have migrainous features during exacerbation phase. Up to 70% patients may fulfill the diagnostic criteria for migraine during exacerbations. Besides migraine, its exacerbations can mimic a large number of other primary and secondary headaches. The other specific feature of HC is a remarkable response to indomethacin. However, a large number of patients develop side effects because of the long-term use of indomethacin. A few other medications may also be effective in a subset of patients with HC. Various surgical interventions have been suggested for patients who are intolerant to indomethacin. Several aspects of HC are still not defined. There is a great heterogeneity in types of patients or articles on the HC in the literature. Diagnostic criteria have been modified several times over the years. The current diagnostic criteria are too restrictive in some aspects. We suggest a more accommodating type of criteria for the appendix of International Classification of Headache Disorder (ICHD).

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Treatment of hemicrania continua with radiofrequency ablation and long-term follow-up

Cited by 12 publications

References 22 publications

Interventional Radiofrequency Treatment for the Sympathetic Nervous System: A Review Article

Interventional Radiofrequency Treatment for the Sympathetic Nervous System: A Review Article

Chronic persistent Horner’s syndrome in trigeminal autonomic cephalalgia subtypes and alleviation with treatment: two case reports

Hemicrania continua: clinical review, diagnosis and management

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