Funct Neurol
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Clinical Trial
Radiofrequency cervical zygapophyseal joint neurotomy for cervicogenic headache: a prospective study of 15 patients.
The present study assessed the clinical efficacy of radiofrequency cervical zygapophyseal joint neurotomy in patients with cervicogenic headache. Fifteen consecutive patients with cervicogenic headache were treated and then assessed one week prior to treatment and, at short-term (8 weeks), intermediate (mean 8.8 months) and long-term (mean 16.8 months) follow-ups. The following were taken as outcome parameters: Visual Analogue Scale (VAS), 7-point Verbal Rating Scale (VRS), number of headache days per week and analgesic intake per week. ⋯ Mean VAS decrease was 31.4 mm (p < 0.001) and 53.5 mm (p < 0.0001) respectively in this period. The average mean number of headache days per week decreased from 5.8 days to 2.8 days (p = 0.001) and the average analgesic intake per week showed a reduction from a mean of 17.5 tablets to a mean of 3.4 tablets (p = 0.003). A definitive conclusion about the clinical efficacy of this treatment can only be drawn from a randomized controlled trial.
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Skin roll tests were performed on 15 patients with cervicogenic headache, 15 with tension headache ("tension-type headache"; 6 with the acute ("episodic") and 9 with the chronic form), and 43 migraine without aura patients (15 without and 28 with sideshift). Three positions (trapezius, mandibular, supraorbital) were used. The results were compared with those obtained in a control series (no. = 95). ⋯ In the cervicogenic headache group, both tenderness and skinfold thickness showed significantly higher values on the symptomatic than on the non symptomatic side in the trapezius position, but not in the other positions. The differences between cervicogenic headache on the one hand and tension headache/migraine on the other were generally rather small, indeed, there was a considerable overlap between the groups. In single cases, therefore, the skin roll test will contribute little to the differential diagnosis of cervicogenic headache.