Refractory Migraine Eliminated by Pulse Radiofrequency to Superior Cervical Ganglion -Good for Chronic Neck Pain as well

Awe inspiring case of chronic migraine headaches eliminated by pulsed radiofrequency (low burn) to a neck sympathetic ganglion.

Carcamo, Cesar R.
Pulsed Radiofrequency of Superior Cervical Sympathetic Ganglion for Treatment of Refractory Migraine.
Pain Medicine 18.8 (2017): 1598-1600.
https://academic.oup.com/painmedicine/article/18/8/1598/2833958

  • 24 year old with frequent drug-unresponsive migraine headaches
  • “PRF lesioning was performed for a total of five cycles of 120 seconds each. The preset maximal temperature was 45 °C and 70 V using a NeuroTherm NT1,000 (NeuroTherm, Inc., Middleton, MA, USA) radiofrequency generator.”
  • completely free of headaches for 10 month followup
  • they felt “sympathetic block may involve a reduction in the neuroinflammatory process”

superior cervical ganglion is at level of c3 anterior to vertebral body and close to carotid artery

article uses ultrasound monitoring to guide but it refers to another article:

Koning, Henk M., et al. Percutaneous radiofrequency lesion of the superior cervical sympathetic ganglion in non-traumatic neck pain.
The Pain Clinic 12.4 (2000): 271-279.
https://s3.amazonaws.com/academia.edu.documents/42121361/Percutaneous_radiofrequency_lesion_of_th20160205-30232-1ljes4y.pdf?AWSAccessKeyId=AKIAIWOWYYGZ2Y53UL3A&Expires=1522649321&Signature=kRKaj6bbZq7uRx2%2Bc2fgnjGq%2BDA%3D&response-content-disposition=inline%3B%20filename%3DPercutaneous_radiofrequency_lesion_of_th.pdf

they used xray imaging but gave better idea of how injected:

  • entry  point  of  the  needle  is  chosen  overly-ins  the  facetal  column  at  the  level  of  the  third  cervical  vertebrae
  • advanced  until  the  tip  is  situated  a  few  millimeters  anterior  to  the  anterior border  of  the  vertebral  bodies
  • appears to be anterior to longus collis but below/ lateral to carotid carotid

 

  • article radiofrequencied 100 cases of non-truamatic neck pain.
  • most  patients  (93%) rated  their  pain  intensity  as  serious  or  intolerable
  • 6% had temporary worsening of pain lasting up to 2 months;     “4% reported  a  change  in  sensibility  in  the  painful  region ” ?more tender or more numb??
  • 1/2 got some relief and “two  years after  the  treatment,  the  maintenance  of  pain  relief  occurred  in  eighty  per  cent  of  the  patients responding  to  this  therapy”

Comment – remarkable results but few trained to do this procedure; first article is from Chile. Going in over c3 facet is exactly where upper superficial cervical plexus lies and so you might end up going through it to get to this deeper ganglion. Hopefully more will be published on this subject as it sounds very promising.

 

 

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