Whiplash Patients with Cervicogenic Headache After Lateral Atlanto- Axial Joint Pulsed Radiofrequency Treatment

Background: Whiplash patients regard cervicogenic headache (CEH) as the most burden- some 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 whip- lash patients with CEH who had undergone antero-lateral atlantoaxial joint pulsed radio- frequency 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 treat- ment can only be tentatively viewed as a promising treatment modality for whiplash pa- tients with CEH and is subject to validation in future studies.