Columbia University College of Physicians and Surgeons, Columbia University Medical Center/New York Presbyterian Hospital, New York, NY, USA.
Pain Physician. 2012 Sep-Oct;15(5):E719-24.
Hemicrania continua (HC) is an uncommon primary headache disorder in which the diagnosis centers on unilaterality and its absolute responsiveness to indomethacin. We describe 3 patients with a long standing history of headache diagnosed as hemicrania continua. There was profound response to indomethacin which was limited by side effects. In one patient the therapy with indomethacin was limited secondary to co-morbidities. Initial diagnostic blockade provided significant relief of symptoms based on which radio-frequency ablation of the supraorbital nerve was performed with substantial improvement in symptoms. Traditionally, hemicrania continua has been managed exclusively with oral analgesics and is defined by its singular response to indomethacin. Radio-frequency ablation (RFA) has been reported in the literature for multiple indications. This case series is unique in that it describes 3 patients diagnosed with hemicrania continua with pain referred in the supraorbital nerve distribution, who underwent radiofrequency ablation of the supraorbital nerve with resultant resolution of headaches. Traditionally, hemicrania continua has been managed exclusively with oral analgesics and is defined by its singular response to indomethacin. This report is unique in that it describes three patients diagnosed with hemicrania continua with pain referred in the supraorbital nerve distribution who underwent radiofrequency ablation of the supraorbital nerve with resultant resolution of headaches. After the RFA medical management was minimal to none in both patients. Though the utility and cost efficacy of RFA of peripheral nerves needs to be confirmed in well-designed trials we present these cases as an example of how this minimally invasive technique can safely provide analgesia in a difficult to treat cephalgia. Moreover if precise anatomical localization of the headache is possible then diagnostic blockade of the appropriate peripheral nerve may be performed followed by radiofrequency ablation to provide potentially more sustained analgesia in patients where medical management is ineffective or poorly tolerated.
丛集性头痛（HC）是一种罕见的原发性头痛疾病，其诊断中心在于单侧性和对吲哚美辛的绝对反应性。我们描述了 3 例长期头痛病史的患者，被诊断为丛集性头痛。这些患者对吲哚美辛有明显的反应，但由于副作用而受到限制。在 1 例患者中，由于合并症的限制，吲哚美辛治疗受限。根据初始诊断性阻滞，患者症状显著缓解，随后行眶上神经射频消融术，症状明显改善。传统上，丛集性头痛仅通过口服镇痛药进行治疗，其特征是对吲哚美辛的单一反应。射频消融（RFA）在文献中有多种适应症的报道。本病例系列的独特之处在于，它描述了 3 例被诊断为丛集性头痛的患者，疼痛放射到眶上神经分布区，接受了眶上神经射频消融术，头痛得到缓解。传统上，丛集性头痛仅通过口服镇痛药进行治疗，其特征是对吲哚美辛的单一反应。本报告的独特之处在于，它描述了 3 例被诊断为丛集性头痛的患者，疼痛放射到眶上神经分布区，接受了眶上神经射频消融术，头痛得到缓解。RFA 后，这 2 例患者的药物治疗均降至最低。尽管外周神经射频消融的实用性和成本效益需要在精心设计的试验中得到证实，但我们提出这些病例是为了说明这种微创技术如何安全地为难以治疗的头痛提供镇痛，而且如果能够精确定位头痛的解剖位置，那么可以对相应的外周神经进行诊断性阻滞，随后进行射频消融，为那些药物治疗无效或不能耐受的患者提供潜在更持久的镇痛。
