Whiplash Patients with Cervicogenic Headache After Lateral Atlanto- Axial Joint Pulsed Radiofrequency Treatment (original) (raw)
Related papers
Surgical Neurology, 2008
The aim of this study is to assess the efficacy of pulsed RF lesioning of cervical medial branches in patients with whiplash-related chronic cervical zygapophysial joint pain in whom other conservative treatments failed. Cervical zygapophysial joint pain was confirmed in 14 patients undergoing double diagnostic blocks. These patients underwent pulsed RF lesioning of the cervical medial branches. Pulsed RF procedures were performed in 2 cycles of 180 seconds after localization under fluoroscopy guide. Twelve (85.7%) patients had substantial pain relief at 1 month. Eleven (78.3%) patients still had more than 60% pain relief at 6 months. Only 5 (35.7%) patients recurred within 12 months. At 12-month follow-up, 9 (64.3%) patients had significant pain improvement. Medication requirements decreased in 13 (92.8%) patients at 1 month, 12 (85.7%) patients at 6 months, and 10 (71.4%) patients at 12 months. Pulsed RF of cervical medial branches is a potential treatment for patients with chronic whiplash-related cervical zygapophysial joint pain that failed other conservative treatments. This treatment provides long-lasting pain relief and reduces pain medication requirements.
Pain Practice, 2010
The lateral atlantoaxial joint has long been reported as a source of cervicogenic headache. We present a retrospective study, including 86 patients who had undergone lateral C1-2 joint pulsed radiofrequency application, for cervicogenic headache in a single pain center from March 2007 to December 2008. The percentage of patients who had 350% pain relief at 2 months, 6 months, and 1 year were 50% (43/86), 50% (43/86), and 44.2% (38/86), respectively. Longterm pain relief at 6 months and 1 year were predicted reliably by Ն50% pain relief at 2 months (P < 0.001). Apart from 1 patient that complained of increased severity of occipital headache lasting several hours, we had no other reported complications.
Headache subsequent to whiplash
Current Pain and Headache Reports, 2009
Methodology varies greatly in whiplash studies; therefore, results are not directly comparable. Headache seems to be present in 50% to more than 75% of cases in the acute stage, and in 20% to 30% of cases in the early chronic stage. Headache naturally occurs frequently (> 75% of the cases [eg, medico-legal cases]) in patients who consult headache specialists due to protracted symptoms. Malingering may explain some cases, and continuation/activation of prewhiplash headache may explain other cases. De novo headache also seems to occur. This headache may partly have cervicogenic headache characteristics: side-locked unilaterality and occipital onset. In one study, this type of headache was present in 8% at 6 weeks and 1% at 6 years. It was more rare than postwhiplash, unspecifi ed headache. De novo postwhiplash headache may consist of cervicogenic headache and of noncervicogenic headache (probably in the acute phase).
A review of the literature on whiplash associated disorders
RAND Europe was asked by the Swiss Insurance Association (SIA) to study what treatment strategies are appropriate in dealing with whiplash associated disorders (WAD), with a specific focus on prevention of long-term disability. The main objectives of the study are:
European Journal of Neurology, 2006
Acute and chronic headache attributed to whiplash injury are new diagnostic entities in the International Classification of Headache Disorders, second edition. A main objective of the present study was to assess the validity of these nosologic entities by studying the headache pattern in an inception cohort of 210 rear-end car collision victims and in 210 matched controls. Consecutive drivers involved in rear-end collisions were identified from the daily records of the Traffic Police Department of Kaunas, Lithuania. A standard self-report questionnaire was sent to the drivers between 2 and 7 days after the collision, and their passengers were recruited as well. Headache and neck pain were evaluated within 7 days of the collision, at 2 months and 1 year after the collision. A control group of non-traumatized subjects received questionnaires at the time of the selection and 1 year later. Of the 75 collision victims who developed headache within the first 7 days of the collision, 37 had a clinical picture in accordance with the criteria for acute whiplash headache (i.e., concomitant neck pain) and 38 did not. For acute headache after collision, concomitant neck pain was of no relevance to the headache type or its course. In both these subgroups, migraine and tension-type headache could be diagnosed in similar proportions and the prognosis after 2 months and 1 year was also similar. Preexisting headache was a strong prognostic factor in both groups for both acute and chronic pain. Compared with the non-traumatized control group, the 1-year incidence of new or worsened headache, or of headache improvement, was the same. A likely interpretation of the data is that acute headaches after rear-end car collisions mainly represent episodes of a primary headache precipitated by the stress of the situation. We conclude that the nosologic validity of both acute and chronic whiplash headache is poor as the headaches, in accordance with the criteria lack distinguishing clinical features and have the same prognosis compared with headaches in a control group.
Cervical Whiplash: Assessment, Treatment, and Impairment Rating
2000
Whiplash-associated disorder (WAD) refers to complaints attributed to a shearhyperextension then hyperflexion cervical injury, typically following a rearend motor vehicle collision (MVC). WAD is often challenging; and requires thoughtful assessment of diagnosis, causation, treatment, disability, maximal medical improvement, and impairment. Neck pain and headaches are common following motor vehicle collisions, but there is significant variation in the duration of symptoms. Research suggests chronic whiplash symptoms should be the exception rather than the rule; and most cases of WAD resolve without permanent impairment. Many factors influence the development of chronic whiplash symptoms including preexisting pathology (physical and/or psychological), the severity of the injury, individuals' expectations of pain and disability following a collision, cultural influences, and psychosocial stressors. Clinical evaluation and treatment guidelines derived from the best scientific knowledge available have failed to alter the epidemic of chronic whiplash symptoms in the United States and other countries, probably because they focus on biological treatment of WAD, ignoring cultural, psychological, and sociological influences. Given the questionable nature of much of the treatment rendered for WAD, this article will discuss appropriate care of whiplash, and a progressive approach to management, followed by impairment evaluation. Clinical Perspective Each year 5.5 million people are injured in motor vehicle collisions in the United States 1 including 2.9 million whiplash injuries. 2 Most (78%) patients report symptoms at the scene 3 , with 93% becoming symptomatic within 15 hours. 4 Neck pain generally must be present for inclusion in any statistics or study on WAD. The next most common presenting complaint is headache (17-33%), followed by upper extremity pain (6-13%). 5 Constant symptoms are reported by 43%, while the remaining 57% report intermittent complaints. 6 Recovery from acute whiplash follows a predictable course, with the majority of uncomplicated WAD cases recovering in four to six weeks. 3, 7 However, there is significant variation in the prevalence of chronic
Pain Physician, 2014
Background: Individuals with chronic whiplash associated disorder (WAD) demonstrate various psychological features. It has previously been demonstrated that cervical radiofrequency neurotomy (cRFN) resolves psychological distress and anxiety. It is unknown if cRFN also improves or reduces a broader spectrum of psychological substrates now commonly identified in chronic whiplash, such as post-traumatic stress disorder (PTSD) and pain catastrophizing. Objectives: To determine if reducing pain in the cervical spine (following cRFN) significantly reduces psychological features (distress, pain catastrophizing and post-traumatic stress symptoms) in individuals with chronic WAD. Setting: Tertiary spinal intervention centre in Calgary, Alberta, Canada. Study Design: Prospective observational study of consecutive patients. Methods: Patients: Fifty-three individuals with chronic whiplash associated disorder symptoms (Grade 2). Intervention: Cervical RFN following successful response to cervic...
Background: Chronic headache after whiplash injury is common, but the underlying mechanisms have not yet been elucidated. On the basis of human neuroanatomy, we hypothesize that rear-end collision can cause leakage of the cerebrospinal fluid (CSF) into the epidural space most frequently at the lumbosacral level, inducing chronic headache. Methods: We considered that the following phenomena would be evident in patients with chronic headache after rear-end collision: (1) orthostatic headache with early onset and long duration, (2) low intracranial pressure (ICP ≤ 60 mm H 2 O), (3) CSF leakage mainly in the lumbosacral region on radioisotope-myelocisternography, and (4) diffuse pachymeningeal enhancement (DPE) on gadolinium enhanced magnetic resonant image (Gd-MRI). The clinical signs and symptoms, ICP and neuroimaging findings were analyzed retrospectively in 20 patients who complained of chronic headache after rear-end collisions. Results: Headaches were orthostatic and started on the day of the accident in 14 patients. The headaches lasted more than 3 months in all patients. Mean ICP was 120 ± 30 cm H 2 O. Only one patient showed low ICP. RI-myelocisternography revealed signs of CSF leakage at the lumbosacral level in 10 patients. Gd-MRI showed no abnormalities known to be characteristic of spontaneous intracranial hypotension (SIH). Chronic headache disappeared or was diminished in all patients by epidural blood patching in the lumbosacral region. Conclusion: This clinical study partly supports the validity of our verifiable hypothetical mechanism. The ICP is not low and DPE is not observed on Gd-MRI. Therefore, CSF leakage into the epidural space may not occur, but spinal CSF absorption may be over-activated. This condition may represent a new clinical entity.
Pathology and Treatment of Traumatic Cervical Spine Syndrome: Whiplash Injury
Advances in Orthopedics, 2018
Traumatic cervical syndrome comprises the various symptoms that occur as a result of external force such as that of a traffic accident. In 1995, the Quebec Task Force on whiplash-associated disorders (WAD) formulated the Quebec classification, with accompanying clinical practice guidelines. These guidelines were in accordance with the stated clinical isolated or combined symptoms of the syndrome: neck pain, headaches, dizziness, numbness of head or face, eye pain, vision loss, double vision, tinnitus, hearing loss, nausea, and numbness and/or weakness of extremities. In recent years, cerebrospinal fluid hypovolemia or fibromyalgia has been recognized as a major notable cause of a variety of symptoms, although many clinical questions remain regarding the pathology of this syndrome. Therefore, its diagnosis and treatment should be conducted extremely carefully. While the Quebec classification and its guidelines are very useful for the normalization and standardization of symptoms of t...