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Pu LL, Miller E, Schenk R. Utilizing directional preference in the management of cervicogenic headache: a case series. J Man Manip Ther 2023; 31:466-473. [PMID: 37261421 PMCID: PMC10642309 DOI: 10.1080/10669817.2023.2217592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 05/10/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND/PURPOSE Headaches are among the most common complaints requiring medical care, and annual expenditures for this condition are estimated to be 14 billion US dollars. The International Headache Society (IHS) describes cervicogenic headache (CGH) as a secondary type of headache emanating from the cervical spine which may be referred to one or more regions of the head and/or face. Mechanical Diagnosis and Therapy (MDT) is an approach shown to be effective in the management of spinal musculoskeletal disorders; however, there is limited evidence as to its efficacy in the management of CGH. The purpose of this case series was to examine the MDT approach in the assessment, classification, and management of a sample of patients experiencing cervicogenic headache. CASE DESCRIPTION This study was a prospective case series. Following IRB approval, 15 patients meeting the study inclusion criteria were recruited from a hospital-based outpatient physical therapy clinic. All subjects received a physical therapy examination by a Diploma trained MDT clinician which included but was not limited to patient self-report forms and the testing of repeated end range movements. The Numerical Pain Rating Scale (NPRS), Neck Disability Index (NDI), Headache Disability Index (HDI), Yellow Flag Risk Form (YFRF), Cervical Flexion Rotation Test (CFRT), and the Craniocervical Flexion Test (CCFT) were administered at the initial visit, 5th visit, and 10th visit or discharge, whichever occurred first. The NPRS, NDI, and HDI were re-administered at a 3 month follow up. Following the initial examination, patients were classified into the MDT categories of derangement, dysfunction, postural, or 'other' and then received intervention based on directional preference. OUTCOMES Fifteen subjects (mean age, 45.9 years; F = 11, M = 4; symptom duration, 44.3 months; average visits, 8.8) received an examination and intervention and completed follow-up outcome measures. Based on MDT classification criteria, all 15 subjects in this case series were classified as derangements. A non-parametric Friedman test of Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation differences among repeated measures was conducted on all outcome measures revealing statistically significant improvements in NPRS (p < .01), NDI(p < .01), and HDI (p < .01) scores at visit 10 and 3 month follow up. The mean change scores exceeded the minimal clinical important difference (MCID) for NPRS (4.2), NDI (7.6), and HDI (28.5). CCFT scores improved significantly from the initial examination to visit 5 (p < .01) and YFRF scores improved significantly between visits 5 and 10 (p < .01). DISCUSSION/CONCLUSION The diagnosis of CGH is difficult to determine based on pathoanatomical assessment. This case series suggests that the patient's response to repeated end range movements may indicate a directional preference for manual procedures and exercises which may be used in management of musculoskeletal conditions such as CGH.
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Affiliation(s)
- Lan Lin Pu
- Faith Regional Health Services, Department of Physical Therapy, Norfolk, NE, USA
| | - Eric Miller
- Program in Physical Therapy, D’Youville University, Buffalo, NY, USA
| | - Ronald Schenk
- Department of Physical Therapy, Tufts University School of Medicine, Boston, MA, USA
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Ekhator C, Urbi A, Nduma BN, Ambe S, Fonkem E. Safety and Efficacy of Radiofrequency Ablation and Epidural Steroid Injection for Management of Cervicogenic Headaches and Neck Pain: Meta-Analysis and Literature Review. Cureus 2023; 15:e34932. [PMID: 36938280 PMCID: PMC10016315 DOI: 10.7759/cureus.34932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 02/17/2023] Open
Abstract
Dysfunction of the cervical spine and its anatomical features, mostly innervated by the C1, C2, and C3 spinal nerves, can result in a secondary headache known as cervicogenic headache (CHA), mainly characterized by unilateral pain. The usefulness of pharmaceutical medications and physical therapy is currently the subject of scant literature. Interventional pain management techniques can be applied when conservative treatment is unsuccessful. This study looks at radiofrequency ablation (RFA) and epidural steroid injection (ESI) to identify their safety and efficacy in managing patients with cervicogenic headaches and neck pain. Three databases - PubMed, Cochrane CENTRAL Library, and Embase were searched, and 110 studies were identified. Nine screening processes were included for review and meta-analysis. Statistical evaluation was conducted through STATA version 17 (College Station, TX: StataCorp LLC) and effect measures were reported through random effects model risk ratios. The main subject of focus included three following outcomes: incidences of pain relief, degree and duration of pain, and incidences of adverse effects. The findings showed both interventions relieved pain by a factor of >50%, demonstrating a relative effects risk ratio of 1.45 (-0.50, 3.39) for RFA: pain relief, 84.76 (82.82, 86.69) RFA: adverse effects, and 19.46 (18.80, 20.11) ESI: pain relief at 95% confidence interval. The efficacy of RFA and ESI differ. Both interventions are effective in the reduction of cervicogenic headache pain intensity. However, their complication rates and pain duration are considerably different. With ESI, the headaches can still recur weekly, demanding the use of oral analgesics to deal with them. On the other hand, RFA has a low complication rate. Improving guidance from imaging technologies, RFA has the potential to be the most effective interventional treatment.
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Affiliation(s)
- Chukwuyem Ekhator
- Neuro-Oncology, New York Institute of Technology, College of Osteopathic Medicine, Old Westbury, USA
| | - Alyssa Urbi
- Neuro-Oncology, Brandeis University, Boston, USA
| | - Basil N Nduma
- Internal Medicine, Merit Health Wesley, Hattiesburg, USA
| | - Solomon Ambe
- Neurology, Baylor Scott and White Health, Mckinney, USA
| | - Ekokobe Fonkem
- Neuro-Oncology, Baylor Scott and White Health, Temple, USA
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Beduhn B, Roe G, Furst W, Lewno A. Head Pain in the Competitive Aquatic Athlete-An Approach to a Differential Diagnosis and Management. Curr Sports Med Rep 2022; 21:398-404. [PMID: 36342394 DOI: 10.1249/jsr.0000000000001010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
ABSTRACT Aquatic athletes not only face common headache etiologies similar to the general population and land-based athletes but also experience their own unique pathology. Posture, aquatic pressure, equipment, and even marine animals pose as unique causes to head pain in the aquatic athlete. Common head pain pathologies seen in the aquatic athlete include tension-type headaches, migraines, cluster headaches, and compressive headaches, including supraorbital neuralgia. Creating a thorough but focused differential diagnosis for head pain in the aquatic athlete can be a difficult and overwhelming task for some. We review both the common and not-so-common etiologies of head pain in the aquatic athlete and suggest a simple framework for assessment and treatment to diagnose and treat head pain in this specific population.
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Affiliation(s)
- Benjamin Beduhn
- Swedish Health, Department of Physical Medicine & Rehabilitation, Rehabilitative Performance Medicine, Seattle, WA
| | - Garrett Roe
- Department of Family Medicine, University of Michigan, Ann Arbor, MI
| | - Wendy Furst
- Department of Family Medicine, University of Michigan, Ann Arbor, MI
| | - Adam Lewno
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
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Blumenfeld A, McVige J, Knievel K. Post-traumatic headache: Pathophysiology and management - A review. JOURNAL OF CONCUSSION 2022. [DOI: 10.1177/20597002221093478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Post-traumatic headache (PTH) is a common secondary headache due to traumatic brain injury. In the past, significant research has been conducted to understand the pathophysiology and treatment options for PTH. However, PTH still lacks evidence-based treatment, and most of the management depends on the primary phenotype observed in the patient. Objective The main objective of this review is to provide a single reference that covers the current understanding of the pathophysiology and the treatment options available for PTH. Methods A detailed literature search on PubMed was performed, and a narrative review was prepared. Results The pathophysiology of PTH is multifactorial. Acute PTH may be attributed to increased peripheral pain sensitization with impaired pain inhibiting pathways. Chronic or persistent PTH may be due to a chronic inflammatory response and peripheral as well as central sensitization. The mechanism responsible for the transition of acute to persistent PTH is unknown. The migraine-like phenotype is reported to be the most prevalent headache type seen in PTH. New targets for preventive treatment have been identified in recent years, such as neuropeptides like calcitonin-gene-related peptide (CGRP), nitric oxide, and glutamate. The preventive pharmacological and non-pharmacological strategies employed for migraine (e.g. anti-CGRP monoclonal antibodies, onabotulinumtoxinA, physical therapy, cognitive and behavioral treatment, and neurostimulation techniques) have shown in preliminary studies that they are potentially efficacious, but large, randomized, double blind, placebo controlled trials are needed to further establish these as treatment options for PTH. Conclusions The lack of evidence-based treatment for PTH has created a need for future large trials to confirm the safety and efficacy of the currently employed treatments.
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Affiliation(s)
- Andrew Blumenfeld
- The Los Angeles Headache Center and The San Diego Headache Center, Los Angeles, CA, USA
| | | | - Kerry Knievel
- Barrow Neurological Institute, Phoenix, Arizona, USA
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Botelho WGN, Signori LS, César ARDA. Occipital nerve block and Maitland physiotherapy: review of treatment techniques based on positive results. HEADACHE MEDICINE 2021. [DOI: 10.48208/headachemed.2021.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Cervicogenic headache is a clinical condition that has a direct impact on quality of life and labor productivity and its underdiagnosis and lack of consensus on the appropriate treatment aggravates even more the condition. This work aims to systematize the protocol that has the highest success rate so far, based on the study carried out in Pindamonhangaba, São Paulo, Brazil. The results demonstrated with the occipital block and Maitland physiotherapy were exceptional and its methodology will be carried out as performed during the study.
Conclusion: Regardless of the substance used for the blockade, its combination with Maitland's physiotherapy was shown to be favorable and its description can help other professionals and also enable reproduction in other studies.
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Xiao H, Peng BG, Ma K, Huang D, Liu XG, Lv Y, Liu Q, Lu LJ, Liu JF, Li YM, Song T, Tao W, Shen W, Yang XQ, Wang L, Zhang XM, Zhuang ZG, Liu H, Liu YQ. Expert panel's guideline on cervicogenic headache: The Chinese Association for the Study of Pain recommendation. World J Clin Cases 2021; 9:2027-2036. [PMID: 33850922 PMCID: PMC8017501 DOI: 10.12998/wjcc.v9.i9.2027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 02/25/2021] [Accepted: 03/18/2021] [Indexed: 02/06/2023] Open
Abstract
Cervicogenic headache (CEH) has been recognized as a unique category of headache that can be difficult to diagnose and treat. In China, CEH patients are managed by many different specialties, and the treatment plans remain controversial. Therefore, there is a great need for comprehensive evidence-based Chinese experts' recommendations for the management of CEH. The Chinese Association for the Study of Pain asked an expert panel to develop recommendations for a series of questions that are essential for daily clinical management of patients with CEH. A group of multidisciplinary Chinese Association for the Study of Pain experts identified the clinically relevant topics in CEH. A systematic review of the literature was performed, and evidence supporting the benefits and harms for the management of CEH was summarized. Twenty-four recommendations were finally developed through expert consensus voting for evidence quality and recommendation strength. We hope this guideline provides direction for clinicians and patients making treatment decisions for the management of CEH.
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Affiliation(s)
- Hong Xiao
- Department of Algology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Bao-Gan Peng
- Department of Orthopedics, The Third Medical Center, General Hospital of the Chinese People’s Liberation Army, Beijing 100039, China
| | - Ke Ma
- Department of Algology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Dong Huang
- Department of Algology, The Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China
| | - Xian-Guo Liu
- Department of Physiology and Pain Research Center, Sun Yat-Sen University, Guangzhou 510080, Guangdong Province, China
| | - Yan Lv
- Department of Algology, Xijing Hospital, Air Force Medical University, Xi'an 710032, Shaanxi Province, China
| | - Qing Liu
- Department of Algology, The Affiliated T.C.M Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Li-Juan Lu
- Department of Algology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
| | - Jin-Feng Liu
- Department of Algology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Yi-Mei Li
- Department of Algology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, Xinjiang, China
| | - Tao Song
- Department of Algology, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Wei Tao
- Department of Neurosurgery, Shenzhen University General Hospital, Shenzhen 518055, Guangdong Province, China
| | - Wen Shen
- Department of Algology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, Jiangsu Province, China
| | - Xiao-Qiu Yang
- Department of Algology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Lin Wang
- Department of Algology, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou Province, China
| | - Xiao-Mei Zhang
- Department of Algology, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan Province, China
| | - Zhi-Gang Zhuang
- Department of Algology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou 450014, Henan Province, China
| | - Hui Liu
- Department of Algology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yan-Qing Liu
- Department of Algology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
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Wang L, Shen J, Das S, Yang H. Diffusion tensor imaging of the C1-C3 dorsal root ganglia and greater occipital nerve for cervicogenic headache. Korean J Pain 2020; 33:275-283. [PMID: 32606272 PMCID: PMC7336345 DOI: 10.3344/kjp.2020.33.3.275] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/16/2020] [Accepted: 05/22/2020] [Indexed: 12/13/2022] Open
Abstract
Background Previous studies showed neurography and tractography of the greater occipital nerve (GON). The purpose of this study was determining diffusion tensor imaging (DTI) parameters of bilateral GONs and dorsal root ganglia (DRG) in unilateral cervicogenic headache as well as the grading value of DTI for severe headache. The correlation between DTI parameters and clinical characteristics was evaluated. Methods The fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values in bilateral GONs and cervical DRG (C2 and C3) were measured. Grading values for headache severity was calculated using a receiver operating characteristics curve. The correlation was analyzed with Pearson’s coefficient. Results The FA values of the symptomatic side of GON and cervical DRG (C2 and C3) were significantly lower than that of the asymptomatic side (all the P < 0.001), while the ADC values were significantly higher (P = 0.003, P < 0.001, and P = 0.003, respectively). The FA value of 0.205 in C2 DRG was considered the grading parameter for headache severity with sensitivity of 0.743 and specificity of 0.999 (P < 0.001). A negative correlation and a positive correlation between the FA and ADC value of the GON and headache index (HI; r = –0.420, P = 0.037 and r = 0.531, P = 0.006, respectively) was found. Conclusions DTI parameters in the symptomatic side of the C2 and C3 DRG and GON were significantly changed. The FA value of the C2 DRG can grade headache severity. DTI parameters of the GON significantly correlated with HI.
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Affiliation(s)
- Lang Wang
- Department of Radiology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Jiang Shen
- Department of Radiology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Sushant Das
- North Sichuan Medical College, Nanchong, China
| | - Hanfeng Yang
- Department of Pain, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
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Lee HJ, Cho HH, Nahm FS, Lee PB, Choi E. Pulsed Radiofrequency Ablation of the C2 Dorsal Root Ganglion Using a Posterior Approach for Treating Cervicogenic Headache: A Retrospective Chart Review. Headache 2020; 60:2463-2472. [PMID: 32052873 DOI: 10.1111/head.13759] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 12/23/2019] [Accepted: 12/23/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To evaluate the efficacy and complications of C2 dorsal root ganglion (DRG) pulsed radiofrequency ablation (RFA) for cervicogenic headache (CEH) and to identify factors related to the outcome of the procedure in this retrospective analysis. BACKGROUND Although conventional high-temperature C2 DRG RFA was effective in patients with CEH in previous studies, the effect of pulsed RFA on C2 DRG in cases of CEH has not yet been evaluated. METHODS We examined the electronic medical records of consecutive patients who underwent C2 DRG block for CEH from January 2012 to May 2018 at a pain center. Consequent C2 DRG pulsed RFA was performed for patients in whom the headache recurred after an initial period of relief 24 hours after the C2 DRG block. A successful outcome was defined as at least 50% pain relief at 6 months after C2 DRG pulsed RFA. We also examined variables associated with the outcome and prognostic factors of CEH. RESULTS Fluoroscopy-guided C2 DRG block was performed in 114 patients with CEH. Forty-five patients received C2 DRG pulsed RFA and 40.0% among them (18/45, success group) had ≥50% pain relief after 6 months. There were no post-procedure complications throughout the study period. Significantly more patients in the success group than in the failure group had a definite positive response (≥50% pain relief) to a previous C2 DRG block (P < .001). CONCLUSION C2 DRG pulsed RFA may be an effective treatment for patients with CEH, particularly for patients who have previously experienced definite pain reduction after C2 DRG block. However, the limitations of our study design and small number of patients preclude firm conclusions.
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Affiliation(s)
- Ho-Jin Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyun Hoo Cho
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seongnam, Republic of Korea
| | - Francis Sahngun Nahm
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seongnam, Republic of Korea.,Department of Anesthesiology and Pain Medicine, Seoul National University, Seoul, Republic of Korea
| | - Pyung-Bok Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seongnam, Republic of Korea.,Department of Anesthesiology and Pain Medicine, Seoul National University, Seoul, Republic of Korea
| | - Eunjoo Choi
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seongnam, Republic of Korea
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Wang L, Das S, Yang H. DTI of great occipital nerve neuropathy: an initial study in patients with cervicogenic headache. Clin Radiol 2019; 74:899.e1-899.e6. [PMID: 31495544 DOI: 10.1016/j.crad.2019.07.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 07/31/2019] [Indexed: 11/19/2022]
Abstract
AIM To assess differences in bilateral great occipital nerves (GONs) in patients with unilateral cervicogenic headache (CEH) using diffusion tensor imaging (DTI). MATERIALS AND METHODS Twenty-three patients with unilateral CEH underwent GON magnetic resonance imaging (MRI). The clinical characteristics and fractional anisotropy (FA) and the apparent diffusion coefficient (ADC) values in bilateral GONs were determined by two observers with 7 and 3 years of experience in MRI. Three segments of GON were defined based on anatomy. The correlation of DTI measurements to the clinical characteristics and inter-/intra-observer performance were also evaluated. RESULTS The mean GON FA for the symptomatic side was significantly lower (0.198±0.056) than that on the other side (0.311±0.04; p=0.000). The mean GON ADC for the symptomatic side was significantly higher (0.682±0.174) than that on the other side (0.465±0.138; p=0.000). Among the three defined segments of GON, statistically significant differences of ADC values were not found at segment S3 (0.692±0.257 versus 0.557±0.230; p=0.068). There were statistically significant differences of FA and ADC values in bilateral GON of segments S1 and S2. The intraclass correlation coefficient (ICC) of intra-/interobserver statistical analysis showed excellent inter/intra-observer agreement for FA and ADC. Significant correlation was only found between the duration and ADC. CONCLUSION In patients with unilateral CEH, quantitative evaluation of the GON using DTI demonstrated FA decreases and ADC increases of the symptomatic side. Larger population and other occipital nerve neuropathy can be included in future research.
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Affiliation(s)
- L Wang
- Department of Radiology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, China; Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong City, Sichuan Province, 637000, China
| | - S Das
- North Sichuan Medical College, Nanchong City, Sichuan Province, 637000, China
| | - H Yang
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong City, Sichuan Province, 637000, China.
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Amrhein TJ, Bozdogan E, Vekaria S, Patel P, Lerebours R, Luo S, Kranz PG. Cross-sectional CT Assessment of the Extent of Injectate Spread at CT Fluoroscopy-guided Cervical Epidural Interlaminar Steroid Injections. Radiology 2019; 292:723-729. [PMID: 31310176 PMCID: PMC6716562 DOI: 10.1148/radiol.2019182795] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 05/01/2019] [Accepted: 06/10/2019] [Indexed: 11/11/2022]
Abstract
Background Previous studies analyzed contrast agent spread during cervical interlaminar epidural steroid injections (CILESIs) by using planar fluoroscopy and reported wide variance of the rate of spread to the ventral epidural space (VES). Cross-sectional CT allows for direct viewing of contrast agent in the VES, providing improved spread assessment and thereby informing needle placement decisions when targeting pain generators. Purpose To determine the extent of injectate spread at CT fluoroscopy-guided CILESI, with particular attention to the VES and bilateral neuroforamina, by using cross-sectional CT. Materials and Methods This study reviewed 83 consecutive CT fluoroscopy-guided CILESIs at which a postprocedural cervical spine CT was performed (June 2016 to December 2017). All procedures used the same injectate (2 mL corticosteroid, 3 mL contrast agent). Postprocedural CT scans were reviewed for the presence of contrast within the VES, dorsal epidural space, ipsilateral neuroforamen, and contralateral neuroforamen in every cervical interlaminar level. Descriptive data are presented as frequencies or means. McNemar tests or hierarchical logistic models were used to assess associations between covariates and contrast agent spread to particular locations. Results The study cohort included 73 individual patients (59% women; 43 of 73) (mean patient age, 57.6 years ± 11.5 [standard deviation]). Mean number of levels of cranial spread were 0.6 level for VES, 1.9 levels for contralateral neuroforamen, 2.1 levels for ipsilateral neuroforamen, and 3 levels for dorsal epidural space. No VES spread in any level was found with 35% (29 of 83) of injections. VES spread was more likely to occur in the level of needle placement (43%; 36 of 83) than in other interlaminar levels (19.5%; 97 of 498; P < .001). Spread was more likely to occur in the neuroforamen ipsilateral to the needle approach compared with contralateral (P < .001). Conclusion Cervical interlaminar epidural steroid injections have injectate spreads with a mean of less than one level cranially in the ventral epidural space (VES) and approximately two levels in the neuroforamen. VES spread occurs more frequently at the level of needle placement and within the ipsilateral neuroforamen. © RSNA, 2019.
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Affiliation(s)
- Timothy J. Amrhein
- From the Department of Radiology (T.J.A., E.B., P.G.K.) and Department of Biostatistics and Bioinformatics (R.L., S.L.), Duke University Medical Center, Box 3808, Box 3850 Durham, NC 27710; Department of Radiology, University of Pittsburgh Medical Center, St. Margaret Hospital, Pittsburgh, Pa (S.V.); and Department of Radiology, University of North Carolina–Chapel Hill, Chapel Hill, NC (P.P.)
| | - Erol Bozdogan
- From the Department of Radiology (T.J.A., E.B., P.G.K.) and Department of Biostatistics and Bioinformatics (R.L., S.L.), Duke University Medical Center, Box 3808, Box 3850 Durham, NC 27710; Department of Radiology, University of Pittsburgh Medical Center, St. Margaret Hospital, Pittsburgh, Pa (S.V.); and Department of Radiology, University of North Carolina–Chapel Hill, Chapel Hill, NC (P.P.)
| | - Sunit Vekaria
- From the Department of Radiology (T.J.A., E.B., P.G.K.) and Department of Biostatistics and Bioinformatics (R.L., S.L.), Duke University Medical Center, Box 3808, Box 3850 Durham, NC 27710; Department of Radiology, University of Pittsburgh Medical Center, St. Margaret Hospital, Pittsburgh, Pa (S.V.); and Department of Radiology, University of North Carolina–Chapel Hill, Chapel Hill, NC (P.P.)
| | - Prasad Patel
- From the Department of Radiology (T.J.A., E.B., P.G.K.) and Department of Biostatistics and Bioinformatics (R.L., S.L.), Duke University Medical Center, Box 3808, Box 3850 Durham, NC 27710; Department of Radiology, University of Pittsburgh Medical Center, St. Margaret Hospital, Pittsburgh, Pa (S.V.); and Department of Radiology, University of North Carolina–Chapel Hill, Chapel Hill, NC (P.P.)
| | - Reginald Lerebours
- From the Department of Radiology (T.J.A., E.B., P.G.K.) and Department of Biostatistics and Bioinformatics (R.L., S.L.), Duke University Medical Center, Box 3808, Box 3850 Durham, NC 27710; Department of Radiology, University of Pittsburgh Medical Center, St. Margaret Hospital, Pittsburgh, Pa (S.V.); and Department of Radiology, University of North Carolina–Chapel Hill, Chapel Hill, NC (P.P.)
| | - Sheng Luo
- From the Department of Radiology (T.J.A., E.B., P.G.K.) and Department of Biostatistics and Bioinformatics (R.L., S.L.), Duke University Medical Center, Box 3808, Box 3850 Durham, NC 27710; Department of Radiology, University of Pittsburgh Medical Center, St. Margaret Hospital, Pittsburgh, Pa (S.V.); and Department of Radiology, University of North Carolina–Chapel Hill, Chapel Hill, NC (P.P.)
| | - Peter G. Kranz
- From the Department of Radiology (T.J.A., E.B., P.G.K.) and Department of Biostatistics and Bioinformatics (R.L., S.L.), Duke University Medical Center, Box 3808, Box 3850 Durham, NC 27710; Department of Radiology, University of Pittsburgh Medical Center, St. Margaret Hospital, Pittsburgh, Pa (S.V.); and Department of Radiology, University of North Carolina–Chapel Hill, Chapel Hill, NC (P.P.)
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GARINIS P, NIKOVA A, BIRBILIS T. [Not Available]. MAEDICA 2019; 14:220-226. [PMID: 31798736 PMCID: PMC6861709 DOI: 10.26574/maedica.2019.14.3.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Objectives:Cervicogenic headache is a chronic cause of pain with a symptomatology varying between neck pain, instability while walking, dizziness, vertigo, ear pain, eye pain, and unilateral tinnitus, which is leading to increased morbidity and use of analgesics. Currently, the contribution of the local infusion of lidocaine in the treatment of cervicogenic headache is very significant. Material and methods:In this pilot study, eight patients with cervicogenic headache were examined between February 2017 and August 2017 and treated with a three-scale method combining: 1) transcutaneous electric nerve stimulation (TENS); 2) minimally invasive methods of lidocaine injections and nerve blocks; and 3) stretching of the cervical and trapezoidal muscles. Results:The results show that the combined three-step therapy decreases both pain intensity based on VAS score and constant use of analgesics. Conclusion:Three-step therapy can be conducted in one session or multiple sessions and appear to constitute a minimally invasive technique that decreases analgesic use, reducing not only their adverse effects and interactions with other pharmaceutics but also the cost of their use.
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Affiliation(s)
- Pavlos GARINIS
- Department of Neurosurgery, Democritus University of Thrace, Alexandroupolis, Greece
| | - Alexandrina NIKOVA
- Department of Neurosurgery, Democritus University of Thrace, Alexandroupolis, Greece,Department of Surgical Oncology, Metaxa Cancer Hospital, Piraeus, Greece
| | - Theodossios BIRBILIS
- Department of Neurosurgery, Democritus University of Thrace, Alexandroupolis, Greece
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Chronic Headache: a Review of Interventional Treatment Strategies in Headache Management. Curr Pain Headache Rep 2019; 23:68. [PMID: 31359257 DOI: 10.1007/s11916-019-0806-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE OF THE REVIEW To provide an overview of current interventional pain management techniques for primary headaches with a focus on peripheral nerve stimulation and nerve blocks. RECENT FINDINGS Despite a plethora of treatment modalities, some forms of headaches remain intractable to conservative therapies. Interventional pain modalities have found a niche in treating headaches. Individuals resistant to common regimens, intolerant to pharmaceutical agents, or those with co-morbid factors that cause interactions with their therapies are some instances where interventions could be considered in the therapeutic algorithm. In this review, we will discuss these techniques including peripheral nerve stimulation, third occipital nerve block (TON), lesser occipital nerve block (LON), greater occipital nerve block (GON), sphenopalatine block (SPG), radiofrequency ablation (RFA), and cervical epidural steroid injections (CESI). Physicians have used several interventional techniques to treat primary headaches. While many can be treated pharmacologically, those who continue to suffer from refractory or severe headaches may see tremendous benefit from a range of more invasive treatments which focus on directly inhibiting the painful nerves. While there is a plethora of evidence suggesting these methods are effective and possibly durable interventions, there is still a need for large, prospective, randomized trials to clearly demonstrate their efficacy.
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Bing N, Tao D, Wei S, Guang L, Hongwei Z. Percutaneous Endoscopic C2-C3 Medial Branches Neurotomy for Cervicogenic Headache. World Neurosurg 2019; 126:498-501. [DOI: 10.1016/j.wneu.2019.03.072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 03/06/2019] [Accepted: 03/07/2019] [Indexed: 02/04/2023]
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Xiao H, Peng B, Ma K, Huang D, Liu X, Lu Y, Liu Q, Lu L, Liu J, Li Y, Song T, Tao W, Shen W, Yang X, Wang L, Zhang X, Zhuang Z, Liu H, Liu Y. The Chinese Association for the Study of Pain (CASP): Expert Consensus on the Cervicogenic Headache. Pain Res Manag 2019; 2019:9617280. [PMID: 31065305 PMCID: PMC6466854 DOI: 10.1155/2019/9617280] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 01/15/2019] [Accepted: 02/24/2019] [Indexed: 02/05/2023]
Abstract
Cervicogenic headache is a relatively common but unique form of headache, and in China, as well as in several other countries, both diagnosis and a clear evidence-based treatment plan remain controversial. Therefore, the Chinese Association for the Study of Pain organized a meeting of pain management experts and created an expert consensus on the diagnosis and treatment of cervicogenic headache in China. This article summarizes the conclusions of the consensus group regarding the epidemiology, etiology, clinical features, diagnosis, differential diagnosis, treatment, and rehabilitation of cervicogenic headache in China.
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Affiliation(s)
- Hong Xiao
- Department of Algology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Baogan Peng
- Department of Orthopedics, General Hospital of Armed Police Force, Beijing, China
| | - Ke Ma
- Department of Algology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dong Huang
- Department of Algology, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Xianguo Liu
- Pain Research Center of Sun Yat-Sen University, Guangzhou, Guang Dong, China
| | - Yan Lu
- Department of Algology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shanxi, China
| | - Qing Liu
- Department of Algology, The Affiliated T.C.M Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Lijuan Lu
- Department of Algology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Jingfeng Liu
- Department of Algology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Yimei Li
- Department of Algology, The First Affiliated Hospital of Xinjiang Medical University, Wulumuqi, Xinjiang, China
| | - Tao Song
- Department of Algology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoling, China
| | - Wei Tao
- Department of Neurosurgery, Shenzhen University General Hospital, Shenzhen, Guangdong, China
| | - Wen Shen
- Department of Algology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Xiaoqiu Yang
- Department of Algology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lin Wang
- Department of Algology, The First Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Xiaomei Zhang
- Department of Algology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Zhigang Zhuang
- Department of Algology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Hui Liu
- Department of Algology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yanqing Liu
- Department of Algology, Beijing Tiantan Hospital, Beijing, China
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Pulsed radiofrequency of the C2 dorsal root ganglion and epidural steroid injections for cervicogenic headache. Neurol Sci 2019; 40:1173-1181. [PMID: 30847672 DOI: 10.1007/s10072-019-03782-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 02/19/2019] [Indexed: 10/27/2022]
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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Abstract
PURPOSE OF REVIEW Headaches encompass a broad-based category of a symptom of pain in the region of the head or neck. For those patients who unfortunately do not obtain relief from conservative treatment, interventional techniques have been developed and are continuing to be refined in an attempt to treat this subset of patients with the goal of return of daily activities. This investigation reviews various categories of headaches, their pathophysiology, and types of interventional treatments currently available. RECENT FINDINGS Injection of botulinum toxin has been shown to increase the number of headache free days for patients suffering from chronic tension-type headaches. Suboccipital steroid injection has been demonstrated as a successful treatment option for patients suffering from cluster headache. Occipital nerve stimulation (ONS) has been described as a treatment for all types of trigeminal autonomic cephalgias. Percutaneous ONS is a minimally invasive and reversible approach to manage occipital neuralgia performed utilizing subcutaneous electrodes placed superficial to the cervical muscular fascia in the suboccipital area. Radiofrequency lesioning is another commonly used treatment in the management of chronic pain syndromes of the head and neck. If a diagnostic sphenopalatine ganglion block successfully resolves the patient's symptoms, neurolysis can be employed as a more permanent solution. Although many patients who suffer from headaches can be treated with conservative, less-invasive treatments, there still remains at present an ever-increasing need for those patients who are refractory to conservative measures and thus require interventional treatments. These procedures are continually evolving to become safer, more precise, and more readily available for clinicians to provide to their patients.
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Incidence of Inadvertent Dural Puncture During CT Fluoroscopy–Guided Interlaminar Epidural Corticosteroid Injections in the Cervical Spine: An Analysis of 974 Cases. AJR Am J Roentgenol 2017; 209:656-661. [DOI: 10.2214/ajr.16.17738] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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