Treatment of hemicrania continua with radiofrequency ablation and long-term follow-up

Jennifer L. Beams, Matthew T. Kline, Todd Rozen

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1208-1213
Number of pages6
JournalCephalalgia
Volume35
Issue number13
DOIs
StatePublished - Jan 1 2015
Externally publishedYes

Keywords

  • anesthesiologic blockade
  • Hemicrania continua
  • indomethacin
  • neuro-stimulator
  • radiofrequency ablation

ASJC Scopus subject areas

  • Clinical Neurology

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