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Pulsed radiofrequency of the C2 dorsal root ganglion and epidural steroid injections for cervicogenic headache

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Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.

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Abbreviations

CEH:

Cervicogenic headache

PRF:

Pulsed radiofrequency

ESI:

Epidural steroid injections

NDI:

Neck disability index

EORTC:

European Organization for Research and Treatment of Cancer

SF:

Social function

CF:

Cognitive function

EF:

Emotional function

RF:

Role function

PF:

Physical function

QL:

Global health score

IQR:

Interquartile range

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Authors and Affiliations

  1. Department of pain management, Wuhan No.1 Hospital, Wuhan, 430022, Hubei Province, China

    Shao-jun Li & Dan Feng

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  1. Shao-jun Li
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  2. Dan Feng
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Correspondence to Dan Feng.

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The study was conducted in accordance with the principles of the Declaration of Helsinki and the guidelines of Wuhan No.1 Hospital.

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Li, Sj., Feng, D. Pulsed radiofrequency of the C2 dorsal root ganglion and epidural steroid injections for cervicogenic headache. Neurol Sci 40, 1173–1181 (2019). https://doi.org/10.1007/s10072-019-03782-x

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