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Treatment of hemicrania continua with radiofrequency ablation and long-term follow-up
Jennifer L Beams1, Matthew T Kline2, Todd D Rozen3
1Geisinger Headache Center, Department of Neurology, Geisinger Health System, USA.
Insights
Patients with hemicrania continua can now avoid indomethacin thanks to novel radiofrequency ablation procedures. These treatments offer long-term headache relief without the need for daily medication.
Area of Science:
- Neurology
- Pain Medicine
- Interventional Headache Procedures
Background:
- Hemicrania continua is a primary headache disorder characterized by continuous unilateral pain with superimposed exacerbations.
- It is defined by its absolute and consistent response to indomethacin.
- Many patients struggle to discontinue indomethacin due to headache recurrence, despite significant risks associated with chronic use.
Observation:
- Four patients with indomethacin-dependent hemicrania continua were unable to cease indomethacin use without symptom recurrence.
- Conventional headache medications were ineffective for these patients.
- Diagnostic blockade of specific neural targets (atlanto-axial joint, C2 dorsal root ganglion, or sphenopalantine ganglion) was performed based on clinical presentation.
Findings:
- Successful diagnostic blockade predicted response to radiofrequency ablation (RFA) of the C2 ventral ramus, C2 dorsal root ganglion, or sphenopalantine ganglion.
- RFA provided complete headache relief, comparable to indomethacin.
- All patients remained headache-free long-term without indomethacin, with one requiring repeat RFA procedures.
Implications:
- Radiofrequency ablation offers a viable, effective alternative to indomethacin for managing hemicrania continua.
- These procedural treatments can significantly improve patient quality of life by eliminating the need for chronic indomethacin.
- Further research into interventional techniques for primary headache disorders is warranted.
Objective:
The objective of this research is to describe novel procedural treatments for hemicrania continua that allow patients to remain off indomethacin.
Methods:
Case reports are presented.
Results:
We describe four distinct patients with indomethacin-responsive hemicrania continua who were unable to discontinue the use of indomethacin without headache recurrence. No other medications were effective for their syndrome. Secondary causes of headache were ruled out in each case. Each patient underwent diagnostic blockade of either the atlanto-axial joint, C2 dorsal root ganglion or sphenopalantine ganglion depending on their clinical examination and presence of cranial autonomic symptoms. A positive response led to a radiofrequency ablation of the C2 ventral ramus, C2 dorsal root ganglion or sphenopalantine ganglion, which provided headache relief in all case patients as complete as indomethacin. Long-term follow-up of these patients has shown that all have remained essentially headache free without the need for indomethacin. One patient has needed repeat radiofrequency procedures with consistent response.
Conclusion:
Hemicrania continua is defined by its sensitivity to indomethacin but very few patients are able to discontinue the medication without headache recurrence. As the risks of chronic indomethacin use are substantial, alternative treatments are necessary to protect patient health. We are now able to suggest several radiofrequency ablation procedures as effective as indomethacin with long-term follow-up.
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