Orhurhu V, Huang L, Quispe RC, et al. Use of Radiofrequency Ablation for the Management of Headache: A Systematic Review. Pain Physician. 2021 Nov;24(7):E973-E987. (Systematic review)

BACKGROUND: Headache is a very common condition that affects 5-9% of men and 12-25% of women in North America and Europe. Globally, the prevalence of active headaches among adults is 47%. The most common type of headache is tension headaches (38% of adults), followed by migraines (10%), and chronic headaches (3%). While the majority of headaches are benign, the disorder can severely negatively influence a patients' quality of life, which is directly reflected in societal costs.

OBJECTIVE: The objective of this review was to summarize available evidence behind radiofrequency ablation (RFA) for headache, including pain outcome measures, secondary outcomes, and complications.

STUDY DESIGN: Systematic review.

SETTING: This systematic review examined studies that applied the use of RFA for management of headache.

METHODS: This systematic review was reported following the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). Two reviewers independently scored the methodological quality of the selected studies. Due to heterogeneity of studies, a best-evidence synthesis of the available prognostic factors was provided.

RESULTS: In the present investigation, we evaluated 18 studies composed of 6 randomized controlled trials (RCTs), 6 prospective studies, and 6 retrospective studies. All the studies assessed pain improvement with RFA in patients with headache. Most studies targeted the occipital nerve for treatment. Complications were mostly mild and self-limiting, including eyelid swelling, rash, superficial infection of the procedural site, and worsening of headache.

LIMITATIONS: A large variability in definitions of trigeminal neuralgia, radiofrequency technique, and patient selection bias was observed in our selected cohort of studies. In addition, there is a paucity of strong longitudinal RCTs and prospective studies.

CONCLUSION: Our review discusses several studies that suggest the efficacy of RFA in the treatment of headaches. Outcomes varied based on the difference in approaches regarding continuous radiofrequency versus pulsed radiofrequency, temperature, and duration of administration. The majority of the studies discussed in this review indicate a therapeutic benefit of RFA for headaches over a short-term period. Pain outcomes beyond one year are understudied and further studies are needed to determine the long-term effects of RFA for headaches.

Discipline Area Score
Physician 5 / 7
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Comments from MORE raters

Physician rater

It seems that the population is somewhat heterogeneous.

Physician rater

This elegant systematic review highlights the benefits of RF ablation for different types of headache at short term follow up. Given how common a problem headache is, the study is definitely relevant to all neurologists and neurosurgeons. It should pave the way for further research in the form of prospective trials in specific headache subsets.
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