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Cryoneurolysis for cervicogenic headache - a double blinded randomized controlled study
Gunnvald Kvarstein1,2, Henrik Högström1, Sara Maria Allen3
1Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.
Scandinavian Journal of Pain
|November 2, 2019
Summary
Percutaneous cryoneurolysis offers temporary pain relief for cervicogenic headache, comparable to corticosteroid injections. Further research is needed to optimize patient selection and techniques for this chronic pain condition.
Area of Science:
- Pain Medicine
- Neurology
- Interventional Pain Management
Background:
- Cervicogenic headache (CEH) is a debilitating condition with limited treatment options.
- Analgesics are often ineffective for CEH, and clinical evidence for percutaneous cryoneurolysis is lacking.
- Cryoneurolysis is a procedure used for pain management, but its efficacy compared to other treatments needs further investigation.
Purpose of the Study:
- To assess the clinical efficacy of percutaneous occipital cryoneurolysis compared to corticosteroid injections for cervicogenic headache.
- To evaluate pain reduction, neck function, quality of life, and psychological distress in patients with CEH.
- To determine the optimal treatment strategy for chronic cervicogenic headache.
Main Methods:
- A randomized, double-blinded, comparative study with 18-week follow-up was conducted.
- 52 eligible patients with CEH were randomly allocated to occipital cryoneurolysis (n=31) or corticosteroid injections (n=21).
- Treatments were guided by diagnostic test blocks, anatomical landmarks, and nerve stimulation.
Main Results:
- Both groups experienced significant pain reduction (>50%) and improved neck function.
- Pain intensity gradually increased after 6-7 weeks but did not return to baseline within 18 weeks.
- Cryoneurolysis showed a more prolonged effect, but group differences were not statistically significant; quality of life and psychological distress improved minimally.
Conclusions:
- Percutaneous cryoneurolysis provides substantial but temporary pain relief for CEH, not significantly superior to corticosteroid injections.
- The study questions the long-term value of occipital cryoneurolysis for chronic CEH, suggesting potential improvements with stricter patient selection and ultrasound guidance.
- Cryoneurolysis may be considered for CEH when non-invasive treatments fail and patients show significant response to test blocks, with awareness of potential risks like neuroma formation.
