Department of pain management, Wuhan No.1 Hospital, Wuhan, 430022, Hubei Province, China.
Neurol Sci. 2019 Jun;40(6):1173-1181. doi: 10.1007/s10072-019-03782-x. Epub 2019 Mar 7.
Cervicogenic headache (CEH) is characterized by unilateral headache symptoms referred to the head from the cervical spine. Few methods have addressed long-term pain relief for CEH. This study was undertaken to evaluate pain control and quality of life after pulsed radiofrequency (PRF) for the C2 dorsal root ganglion and epidural steroid injections (ESI) for CEH.
This was a case-control study. One hundred thirty-nine patients suffering from CEH were enrolled in this study. Of these patients, 87 CEH patients underwent PRF for the C2 dorsal root ganglion and ESI therapy, and 52 CEH patients only underwent ESI therapy. Quality of life and pain control were measured with the European Organization for Research and Treatment of Cancer (EORTC) Quality-of-Life Questionnaire (QLQ-C30) and Izbicki pain scores. Kaplan-Meier curve was used to evaluate the efficacy of the treatment in the groups.
Before therapy, the median of Izbicki pain score in PRF+ESI group and ESI group was 78.5 and 72.5, respectively (p = 0.574). After 2 year follow-up, significant reduction was found in the two groups (11.25 versus 40.00, p < 0.001). The two groups demonstrated an equal distribution of age and gender (p > 0.05). SF (68.52 ± 21.50 versus 50.63 ± 15.42), PF (70.61 ± 29.47 versus 47.87 ± 21.53), RF (52.04 ± 17.92 versus 38.13 ± 24.07), EF (61.17 ± 28.41 versus 43.52 ± 25.48), CF (55.36 ± 19.82 versus 46.82 ± 23.54), and QL (59.31 ± 27.44 versus 50.73 ± 21.90) were significantly higher in PRF+ESI group than in ESI group. Kaplan-Meier curve showed that the probability of treatment success in PRF+ESI group was higher than that in ESI group (median pain relief: ESI group, 4 months; PRF+ESI group, 8 months) (Log-Rank test, p < 0. 001). There was no serious side effect in this study.
The combination of PRF for the C2 dorsal root ganglion and ESI is a relatively safe therapy for CEH. This technique not only provides the sustained relief of pain symptom but improves the quality of life in patients with CEH.
颈源性头痛（CEH）的特征是单侧头痛症状从颈椎向头部放射。很少有方法能长期缓解 CEH 的疼痛。本研究旨在评估脉冲射频（PRF）治疗 C2 背根神经节和硬膜外类固醇注射（ESI）治疗 CEH 的长期疼痛缓解效果。
这是一项病例对照研究。139 例 CEH 患者纳入本研究。其中，87 例 CEH 患者接受 PRF 治疗 C2 背根神经节和 ESI 治疗，52 例 CEH 患者仅接受 ESI 治疗。采用欧洲癌症研究与治疗组织（EORTC）生活质量问卷（QLQ-C30）和 Izbicki 疼痛评分评估生活质量和疼痛控制情况。采用 Kaplan-Meier 曲线评估两组的治疗效果。
治疗前，PRF+ESI 组和 ESI 组的 Izbicki 疼痛评分中位数分别为 78.5 和 72.5（p=0.574）。随访 2 年后，两组疼痛均明显减轻（11.25 与 40.00，p<0.001）。两组年龄和性别分布均衡（p>0.05）。SF（68.52±21.50 与 50.63±15.42）、PF（70.61±29.47 与 47.87±21.53）、RF（52.04±17.92 与 38.13±24.07）、EF（61.17±28.41 与 43.52±25.48）、CF（55.36±19.82 与 46.82±23.54）和 QL（59.31±27.44 与 50.73±21.90）评分 PRF+ESI 组均显著高于 ESI 组。Kaplan-Meier 曲线显示 PRF+ESI 组的治疗成功率高于 ESI 组（中位疼痛缓解时间：ESI 组 4 个月；PRF+ESI 组 8 个月）（Log-Rank 检验，p<0.001）。本研究无严重不良反应。
C2 背根神经节 PRF 联合 ESI 治疗 CEH 相对安全。该技术不仅能持续缓解疼痛症状，还能提高 CEH 患者的生活质量。
