297 - Radiofrequency Thermocoagulation in the Management of Cervicogenic Hea...

#297 Radiofrequency Thermocoagulation in the Management of Cervicogenic Headache

Oral Posters: Cervical

Presented by: E. Emara

Author(s):

E.E. Emara (1)
M. Alsayed (2)
N. Fahmy (3)

(1) Ain Shams University Faculty of Medicine, Neurosurgery Department, Cairo, Egypt
(2) Ain Shams University Faculty of Medicine, Psychiatry Department, Cairo, Egypt
(3) Ain Shams University Faculty of Medicine, Neurology Department, Cairo, Egypt

Abstract

Cervicogenic headache is due to degenerative arthrosis of the C1 and C2 facet joint.In the period between 1996 till 2011 3000 patients were presented in the pain clinic and evaluated by both the pain specialist and the psychiatrist.600 out of these 3000 patients were referred after exclusion of any underlying psychological back grounds.Those 600 patients were evaluated by both the neurologist and the neurosurgeon. X-ray skull open mouth views were done to all patients and CT brain or MRI brain were done to all the patients to exclude other underlying organic etiologies.450 patients did not have any other etiologies apart from C1-C2 arthrosis. All these patients were first managed the conservative measures including medical treatment in the form of gabapentines , non steriodal antiinflammatory agents and muscle relaxants ,physiotherapy in the form of neck retraction extension excercises and instructions to use medical pillows rather than regular ones.200 patients were satisfied by the pain relief result, the other 250 patients were subjected to C2 nerve block.The occipital headche was relieved in all the remaining 250 patients .The pain recurred within few days.the same procedure was repeated with less satisfactory results in 180 patients.Radiofrequency thermocoagulation was done in only 150 patients , the other 30 patients refused the procedure. The occipital headache was excellently relieved in 80 patients, moderately relieved in 45 patients and fairly relieved in 18 patients and there was no response in the remaining 7 patients.There was satisfactory results in 125 out of the 150 patients (83.33%) and fair results in 18 patients(12.oo %) and no response in only 7 patients (0.046 %). Clinical follow up was done only in those 125 patients over 3 to 5 years with mean 48 ± 2 months. The pain recurred in only 90 patients.It was severe requiring the same procedure in 30 patients, but it was moderated in 10 patients who responded well to the previous conservative measures and it was mild in 50 patients who did not ask any medical treatment .The recurrent severe occipital headache occurred only in 30 patients (24%). Radiofrequency was repeated again in those 30 patients .the pain was relieved in only 18 patients. The overall good result of radiofrequency pain relief was 82.4% (103 patients). Radiofrequency thermocoagulation is a safe reversible non destructive procedure.