The Role of Radiofrequency Thermocoagulation
Conventional (Continuous) Radiofrequency thermocoagulation (CRF) and pulsed radiofrequency (PRF) are becoming treatment choices in severe headache cases. PRF differs from CRF as it maintains tissue temperature below 42 °C and prevents possible tissue destruction. We will focus on the PRF technique, mechanisms, and usage in cases of headache resistant to medical treatment. Its usage in trigeminal neuralgia is well known. We will therefore concentrate on the effectiveness of PRF of the sphenopalatine ganglion (SPG) in a resistant cluster headache patient, PRF of the greater occipital nerve (GON) in a cervicogenic headache patient, and PRF of the lesser occipital nerve (LON) in LON neuralgia.
Nerve stimulation is necessary before making an RF lesion. Fluoroscopy, ultrasound, or CT-guided needle placement may be used. The place of the needle should be checked with nerve stimulation. The needle should be replaced under guidance if it is not at the correct localization as determined by the stimulation response.
The mechanism of the analgesic effect of PRF is not well known. These changes take days to develop after the application of PRF and are not related to the temperature.
KeywordsInterventional management Headache Radiofrequency
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