Park Mu Seung, Choi Hyuk Jai, Yang Jin Seo, Jeon Jin Pyeong, Kang Suk Hyung, Cho Yong Jun
Department of Neurosurgery, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon, Korea.
Clin J Pain. 2021 Mar 1;37(3):206-210. doi: 10.1097/AJP.0000000000000911.
Cervicogenic headache has been known to originate from the convergence of the upper 3 cervical and trigeminal afferents. The administration of conservative treatments, interventional procedures, and more recently, pulsed radiofrequency, has been used to relieve cervicogenic headache. In this study, the authors evaluated the clinical efficacy and safety of pulsed radiofrequency targeting the mid-cervical medial branches.
From September 2012 until December 2017, 395 patients were diagnosed with cervicogenic headache based on the third edition of the International Classification of Headache Disorders. The authors treated them conservatively at first, and those patients with nonresolution of pain were treated with mid-cervical medial branches block applied from C3 to C5 twice. Subsequently, if any patient continued to experience persistent pain, the authors classified them as having intractable cervicogenic headache and performed pulsed radiofrequency treatment targeting the mid-cervical medial branches from C3 to C5 bilaterally. The authors analyzed their demographics and used a Visual Analogue Scale to assess their pain for 12 months.
Fifty-seven patients were enrolled in this study. The mean age was 49.8 years, and the mean duration of symptoms was 47.7 months. The mean Visual Analogue Scale score was 6.21 before pulsed radiofrequency treatment, and it improved to 1.54 immediately after the procedure without the symptoms recurring for a minimum of 12 months. There were no severe complications, such as vascular or nerve injuries.
In patients with intractable cervicogenic headache, pulsed radiofrequency treatment targeting the mid-cervical medial branches resulted in a satisfactory, long-lasting outcome without serious complications.
已知颈源性头痛源于上3节颈椎和三叉神经传入神经的汇聚。保守治疗、介入手术以及最近的脉冲射频已被用于缓解颈源性头痛。在本研究中，作者评估了针对颈中部内侧支的脉冲射频的临床疗效和安全性。
从2012年9月至2017年12月，根据《国际头痛疾病分类》第三版，395例患者被诊断为颈源性头痛。作者首先对他们进行保守治疗，对那些疼痛未缓解的患者，采用从C3至C5进行两次颈中部内侧支阻滞治疗。随后，如果任何患者仍持续疼痛，作者将他们归类为难治性颈源性头痛，并对双侧C3至C5的颈中部内侧支进行脉冲射频治疗。作者分析了他们的人口统计学数据，并使用视觉模拟量表评估他们12个月的疼痛情况。
57例患者纳入本研究。平均年龄为49.8岁，平均症状持续时间为47.7个月。脉冲射频治疗前视觉模拟量表平均评分为6.21，治疗后立即改善至1.54，且至少12个月内症状未复发。没有出现严重并发症，如血管或神经损伤。
对于难治性颈源性头痛患者，针对颈中部内侧支的脉冲射频治疗产生了令人满意的长期效果，且无严重并发症。
