c1. Treatment for Cervicogenic Headaches

Treatment for Cervicogenic Headaches:

Pain-relieving medications provide limited benefits in treatment. Physical therapy is known to alleviate cervicogenic headaches by facilitating neck movements and relieving muscle tension in the neck.

When physical therapy and rehabilitation prove ineffective, interventional methods are utilized.

Sources of pain in the neck are neutralized using radiofrequency ablation or nerve blocks.

Interventional Methods for Cervicogenic Headaches:

In the case of cervicogenic headaches, nerves of the neck facet joints can be:

a. Blocked with local anesthetics and steroids.

b. Treated with radiofrequency thermocoagulation.

 

Preparations Before Intervention:

• Firstly, ask your physician to explain the procedure to you in detail. Your physician will request your written consent, as required by law.

• Inform your physician about all other disorders you have, medications you are using, and any substances or medications causing allergies, if any. Herbal medications like vitamin E, glucosamine, garlic, and ginseng can also lead to bleeding.

• It's beneficial to consult your respective physician about stopping all blood-thinning medications, except aspirin.

• Bring all previous examinations, MRIs, CT scans, and laboratory findings with you when going for the procedure.

• Dress comfortably and leave your watch, rings, and other jewelry at home.

• Refrain from eating food or drinking water at least 4 hours before the procedure. However, if you need to take medications for other systemic diseases, they can be taken with a small amount of water.

• As a mild anesthetic procedure called sedation will be applied during the procedure, you won’t be allowed to return home alone. You should come with a companion.

How is Radiofrequency Thermocoagulation Performed, and How Long Does It Take?

• The procedure is conducted in an operating room setting. After being laid on your back, the neck area where the procedure will be performed is numbed with local anesthesia.

• During this time, blood pressure, heart rate, and respiration are continuously monitored by an anesthesiologist.

• The intervention area is determined through fluoroscopy, or imaging, and local anesthetics are applied to the skin area above it.

• Under imaging guidance, electrodes resembling needles reach the facet joint or the nerve of the facet joint.

• A stimulus is given from the electrode to confirm once again that the needle is in the right place.

• A dye is given through the needle to confirm under imaging that the needle is in the right place, hence confirming the needle's position twice.

• Local anesthetic, hyaluronidase, and depot steroid solutions are injected again under imaging through the needle.

• For blocking the nerve of the facet joint, a combination of local anesthetic and steroid or radiofrequency thermocoagulation method is used.

• Waiting for the patient to  is expected to wake up.

• The entry point of the needle is covered in a sterile manner.

• The patient is then taken to the room for observation and is discharged after an average observation period of 2-3 hours.

• The injection is not painful. Sedative drugs and analgesics are given to ensure the patient does not experience pain. Temporary numbness can be felt in the applied area after the procedure.

• Pain decreases. The decrease in pain is the effect of the applied local anesthetic and lasts for about 4-6 hours. Later, the pain returns and a more severe pain than before can be felt for about 5-6 days. A gradual decrease in pain, eventually disappearing, is expected within an average of 3 weeks. The success rate is generally between 50-70%.

• The procedure can be repeated for patients who do not benefit from the first procedure. However, it is not recommended to repeat more than twice within 6 months. Especially in cases known as disk herniation, recovery is generally permanent. In more severe cases, the chance of success is inversely proportional to the duration of the disease.

• Facet joint injections and blocking the nerve of the facet joint have been safely practiced for over 40 years.

• The method is suitable under imaging with electrodes resembling needles. The feature of these electrodes is that they can electronically measure the resistance of the application area in ohms at the tip of the electrode. Hence, the method is not applied when unwanted areas are reached.

• Side effects are very rare. Due to being administered in a limited area and very limited systemic spread, steroid-related side effects are almost never seen

Radiofrequency denervation of the facet joints