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      Pulsed radiofrequency of C2 dorsal root ganglion under ultrasound guidance for chronic migraine: a case report

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          Abstract

          Chronic migraine is common but difficult to treat. Most patients respond poorly to drugs. Occipital nerve block such as stellate ganglion block is an effective treatment without continuous effect for migraine. Pulsed radiofrequency (PRF) technique has been shown to be effective in relieving headache and prolonging the effect of nerve block. This case report is about a patient who suffered from chronic migraine with occipital pain and was successfully treated with PRF of C2 (axis) dorsal root ganglion (DRG) under ultrasound guidance confirmed by computed tomograpy scan. The patient did not feel headache after 1-year follow-up. This suggests that C2 DRG PRF might be considered as an alternative treatment for chronic migraine with occipital pain.

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          Most cited references 17

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          The cost of headache disorders in Europe: the Eurolight project.

          Headache disorders are very common, but their monetary costs in Europe are unknown. We performed the first comprehensive estimation of how economic resources are lost to headache in Europe.   From November 2008 to August 2009, a cross-sectional survey was conducted in eight countries representing 55% of the adult EU population. Participation rates varied between 11% and 59%. In total, 8412 questionnaires contributed to this analysis. Using bottom-up methodology, we estimated direct (medications, outpatient health care, hospitalization and investigations) and indirect (work absenteeism and reduced productivity at work) annual per-person costs. Prevalence data, simultaneously collected and, for migraine, also derived from a systematic review, were used to impute national costs.   Mean per-person annual costs were €1222 for migraine (95% CI 1055-1389; indirect costs 93%), €303 for tension-type headache (TTH, 95% CI 230-376; indirect costs 92%), €3561 for medication-overuse headache (MOH, 95% CI 2487-4635; indirect costs 92%), and €253 for other headaches (95% CI 99-407; indirect costs 82%). In the EU, the total annual cost of headache amongst adults aged 18-65 years was calculated, according to our prevalence estimates, at €173 billion, apportioned to migraine (€111 billion; 64%), TTH (€21 billion; 12%), MOH (€37 billion; 21%) and other headaches (€3 billion; 2%). Using the 15% systematic review prevalence of migraine, calculated costs were somewhat lower (migraine €50 billion, all headache €112 billion annually).   Headache disorders are prominent health-related drivers of immense economic losses for the EU. This has immediate implications for healthcare policy. Health care for headache can be both improved and cost saving. © 2011 The Author(s). European Journal of Neurology © 2011 EFNS.
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            Nerve block for the treatment of headaches and cranial neuralgias - a practical approach.

            Several studies have presented evidence that blocking peripheral nerves is effective for the treatment of some headaches and cranial neuralgias, resulting in reduction of the frequency, intensity, and duration of pain.
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              Comparison of High-voltage- with Standard-voltage Pulsed Radiofrequency of Gasserian Ganglion in the Treatment of Idiopathic Trigeminal Neuralgia.

              Although pulsed radiofrequency treatment (PRFT) has been used to treat trigeminal neuralgia (TN) safely, satisfactory improvement is lacking. Recently, much attention has been paid to the PRFT dose and intra-operative parameters. It has been reported that high-voltage PRFT could significantly reduce discogenic pain. However, there is no study investigating the effects of high-voltage PRFT on TN. The aim of this prospective, randomized, double-blinded study was to evaluate the efficacy and safety of high-voltage PRFT in comparison with standard-voltage PRFT for idiopathic TN. Sixty severe TN patients were randomly assigned to 2 groups treated with CT-guided standard- or high-voltage-pulsed radiofrequency (RF) of Gasserian ganglion, respectively, between January 2012 and July 2012. Numeric Rating Scales (NRS), carbamazepine dose, and side effects were evaluated at day 1, weeks 1 and 2, months 1, 3, and 6, and 1 year postoperative. There were 27 patients in the standard-voltage group and 26 patients in the high-voltage group who completed the 1-year follow-up study. The effective rates in the standard-voltage and high-voltage PRFT groups were 41% and 69%, respectively, at 1, 3, and 6 months postoperative (P = 0.037). The effective rate in the standard-voltage group decreased to 19% at 1-year postoperative, while in the high-voltage group remained at 69% (P = 0.000). No significant side effects were detected in both groups. In conclusion, CT-guided high-voltage PRFT is an effective and safe interventional therapeutic choice for idiopathic TN patients.
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                Author and article information

                Journal
                J Pain Res
                J Pain Res
                Journal of Pain Research
                Journal of Pain Research
                Dove Medical Press
                1178-7090
                2018
                21 September 2018
                : 11
                : 1915-1919
                Affiliations
                [1 ]Department of Pain Management, West China Hospital, Sichuan University, Chengdu, Sichuan Province 610041, People’s Republic of China, zerodq_hx@ 123456163.com
                [2 ]Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province 610041, People’s Republic of China, 769574913@ 123456qq.com
                Author notes
                Correspondence: Ling Ye, Department of Pain Management, West China Hospital, Sichuan University, 37# Guoxue Xiang, Chengdu, Sichuan Province 610041, People’s Republic of China, Email zerodq_hx@ 123456163.com
                Yunxia Zuo, Department of Anesthesiology, West China Hospital, Sichuan University, 37# Guoxue Xiang, Chengdu, Sichuan Province 610041, People’s Republic of China, Tel +86 288 542 2997, Fax +86 288 542 3593, Email 769574913@ 123456qq.com
                [*]

                These authors contributed equally to this work

                Article
                jpr-11-1915
                10.2147/JPR.S172017
                6160264
                © 2018 Li et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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