Cooled Radiofrequency Ablation of Cervical Nerves for Treating Cervicogenic Headache

Cervical facet arthropathy, a degenerative condition of the facet joints, is a leading cause of cervicogenic headaches. First-line therapies such as physical therapy and pharmacology often fail to provide lasting relief. Cooled radiofrequency ablation (RFA) offers a minimally invasive alternative with potential for significant pain reduction.

This retrospective study evaluates the efficacy and safety of cooled RFA for patients with cervicogenic headaches.

This retrospective analysis consisted of 232 procedures from 137 patients who received cooled RFA of the third occipital nerve (TON) and C3 with/out C4, with/out C5 medial branches, between 2015 and 2025 at UW Health. Data collected include pre- and post-operative pain scores assessed through the Visual Analogue Scale (VAS), duration of pain relief, and adverse events. Paired t-tests were used to analyze the data, with p-values ≤ 0.05 considered statistically significant.

A significant reduction in VAS pain scores was observed (p < 0.001). Pain improvement occurred in 62.2% of procedures, with 18.4% achieving complete remission and 19.4% showing no change in pain. Among effective procedures, the average pain reduction was 58.5 ± 32.2%, with a mean duration of 10.1 ± 8.3 months. Twelve procedures were reported to have self-limiting adverse events that resolved within five months.

Cooled RFA of cervical medial branches provides effective, durable, and safe pain relief for chronic neck pain and cervicogenic headaches refractory to conservative care. Broader clinical use may benefit from standardized treatment protocols and further study of long-term outcomes.