Whiplash patients with cervicogenic headache after lateral atlanto-axial joint pulsed radiofrequency treatment

Abstract

Background: Whiplash patients regard cervicogenic headache (CEH) as the most burdensome symptom of their condition. Sufferers experience a significant degree of disability from headache, associated neck pain and disability, and sleep disturbance. Lateral C1/2 joint pulsed radiofrequency (PRF) treatment has been shown to produce significant relief from headache in patients with CEH.

Objectives: The objective of this retrospective questionnaire study of 45 consecutive whiplash patients with CEH who had undergone antero-lateral atlantoaxial joint pulsed radiofrequency treatment (AA PRF) was to evaluate the treatment's long-term effects on pain-related disability and health-related quality of life.

Patients and methods: Four questionnaires were sent to all 45 patients who had undergone AA PRF: 1) The short form-36 (SF-36); 2) The neck disability index (NDI); 3) The medical outcome scale-sleep scale (MOS-SS); 4) The headache impact test-6 (HIT-6). All 45 patients received AA PRF under fluoroscopic guidance. PRF treatment was conducted at 45 V with a pulsed frequency of 4 Hz and a pulsed width of 10 ms for 4 minutes .

Results: Patients who responded to the procedure reported lower pain scores at 2, 6, and 12 months of follow-up compared to nonresponders. More important, patients reported marked improvements in headache impact (P < 0.01), neck-disability scores (P < 0.01), awakening due to headache (P < 0.01), and sleep problems (9-item; P < 0.05) on the MOS-SS. Responders to the procedure also reported a significantly higher health-related quality of life in terms of bodily pain (P < 0.05) and health change (P < 0.01) on the SF-36.

Conclusions: In light of the inherent limitations of our retrospective study, AA PRF treatment can only be tentatively viewed as a promising treatment modality for whiplash patients with CEH and is subject to validation in future studies.

Keywords: Atlanto-Axial Joint; Headache; Pulsed Radiofrequency Treatment; Whiplash Injury.

Figure 1.. Lateral View With a 5º Oblique Tilt for Initial Needle Entry (Left). Postero-Anterior View (Right) of Needle Entry into Lateral C1/2 Joint. Notice the Active Tip Does Not Contact the Intra-Articular Osseous Surface.