Ultrasound-Guided C2 Coblation May Be Effective for Cervicogenic Headache – Clinical Pain Advisor

January 17, 2019

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Cervicogenic headache is caused by upper cervical spine dysfunction involving soft tissue, disk and/or bony components that affect the nerve root, with C2 often implicated.

Treatment of cervicogenic headache with ultrasound-guided C2 nerve root coblation was associated with significant reductions in pain for at least 24 weeks, according to a study published in Pain Medicine.

An increase in the prevalence of cervicogenic headache — a condition caused by upper cervical spine dysfunction involving soft tissue, disk, and/or bony components that affect the nerve root, with C2 often implicated — has been observed. Although coblation has been used across many specialties and clinical scenarios, its utility in treating cervicogenic headache has not been examined.

For this single-center retrospective study, the medical records and pain questionnaires filled out by 26 adults (mean age, 47.50 years; 53.8% women; mean pain duration, 8.85 months) with a history of unilateral cervicogenic headache (17 and 9 patients with right- and left-sided headache, respectively) for at least 6 months were examined. Patients had received C2 nerve coblation between January and June 2017. Pain intensity was reported using a 0 to 10 visual analog scale (VAS), with all patients scoring ≥6 at baseline (ie, 1 day before treatment). Patients were asked to assess pain intensity at days 1 and 3, and 1, 2, 4, 8, 12, 16, 20, and 24 weeks after coblation. Follow-up visits occurred at 4, 12, and 24 weeks after the procedure. The procedure was considered to be clinically efficacious when ≥50% reduction in VAS score from baseline level was achieved.

Prior to coblation, the mean VAS score was 7.38. At 1 day postprocedure, all 26 patients reported >50% pain relief, with a mean VAS score of 1.85 (P <.001 after Bonferroni adjustment). After 3 days, the mean VAS score was 2.00. At 12 weeks, the mean VAS score was 2.96 (P <.001), with 24 of 26 individuals (92.31%) reporting ≥50% reduction in pain from baseline level. At 24 weeks, the mean pain score was 3.08 (P <.008), with 23 of 26 patients (88.46%) sustaining clinical efficacy.

The coblation procedure was well tolerated by all recipients, with no major complications reported. A total of 3 minor complications occurred —1 case of neck torticollis and 2 cases of puncture site ecchymoses — all of which resolved spontaneously, suggesting that coblation may represent a safer alternative to radiofrequency ablation, with less tissue damage.

Study limitations include a small sample size and the inability to compare guidance with ultrasound vs fluoroscopy in a double-blinded manner.

“Our results suggest that C2 nerve coblation is an effective therapeutic strategy to treat [patients with] cervicogenic headache, which can produce significant and long-lasting pain relief. Ultrasound guidance is a convenient and effective method that could provide patients and pain physicians with a nonionized or less ionized exposure environment,” noted the authors.

Funding

This work was supported by the Scientific Research Incubation Project of Beijing Municipal Administration of Hospitals (No. PX2016015), High-level Health and Technical Personnel Training Plan for Beijing Healthy System, Beijing Municipal Commission of Health and Family Planning (No. 2015-3-067), and Fundamental-Clinical Cooperative Research Cooperation Fund of Capital Medical University (No. 16JL50).