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Title: Multimodal Treatment With Pulsed Radio-Frequency (PRF), Botulinum Toxin (BTX-A), Ultrasound Guided Dry Needling (USGDN) For Multifaceted Cervicogenic Headache - A Neuro-Myopathic Disorder
e-poster Number: INSIM108
Category: Pain
Author Name: Dr. Ankush Dipak Wasnik
Institute: Ashirvad Institute for Pain Management and Research
Co-Author Name: Dr. Lakshmi Vas, Dr. Jhanvi Vora-Hemani, Dr. Khyati Patel
Abstract :
Introduction:
Cervicogenic headache (CEH) is a secondary headache with source in the upper cervical spine. Although oral medications and procedures are accepted for its management their efficacy remains limited. We propose a multimodal approach for its treatment.
Aim and Objective:
We believe that CEH is a neuromyopathic disorder which can be efficiently resolved by targeting the nerves and muscles both. We performed PRF of C1,2,3, dorsal scapular and spinal accessory nerve and followed it after 20 days by BTX-A Inj into muscles of neck and upper back. Fine tuning of the BTX-A effect was done by 10 sessions of USGDN of the muscles.
Methodology:
This case series includes 5 patients diagnosed as chronic refractory CEH according to ICHD-3 with severe headache and frequency of attacks 20-25/ month. We noted the pain severity, frequency and quality of life (SF-36) at presentation, post PRF, Pre/post Botox and post USGDN. Observation period was 6 months.
Result:
A positive response to treatment was seen in all patients with dramatic reduction of pain intensity (from 7 ± 1 to 2 ± 2 NRS) and significant decrease in the number of headache days (from 22 ± 5 to 8 ± 4) after PRF & BTX-A treatment. Post USGDN pain intensity further reduced to 1-2/10 NRS and with 2-3 headache days/month. Two patients were totally pain free.
Conclusion:
Our multimodal approach to treat CEH taking into consideration its multi faceted origin resulted in significant resolution of pain and improvement of quality of life of the patients.
