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Radio Frequency Ablation for Cervical Facet Based Headaches?
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Radio Frequency Ablation for Cervical Facet Based Headaches?

Given a helpful albeit, transient result from a Facet block for chronic unrelenting cervicogenic "Tension Headaches," a Radio frequency ablation procedure has been recommended. Neurologist at a headache clinic at an academic hospital tried a myriad of meds (SSRIs, Elavil, Betas, Calciums, Neurontin, Cymbalta, Gabas, Lyrica) & nothing helped. Side effects of most meds only exacerbated the pressure, tightness and hangover-like Neuro & cognitive symptoms. Botox was suggested but is expensive, transient in relief, and not covered by insurer.

Is Radio Frequency Ablation safe & efficacious, and/or do you have any other more benign treatment suggestions?
Thanks for your help
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14 Comments
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Avatar_n_tn
Have you done physical therapy and or acupuncture?  Have you used a TENS unit with heat?  You can rent these to see if they work but they require a prescription.  Most insurers will cover the rental.  

One other idea is to try an Osteopath to see if they can suggest anything.  Personally have not heard of the treatment that has been recommended, so no idea if its effective or not and if longterm its safe.

If you decide to go ahead, ask the Dr if you are able to speak with someone he has treated in the past who has had success, also ask what the success rate is with the procedure.

Best wishes.  One thing I found that triggers migraine for me is orange juice - I was drinking it daily at the time.  Someone told me that her Daughter had headaches after drinking OJ.  I went off it for 6 wks, eventually no migraines unless I ate red dye foods.  I went back on it, got a migraine within 4 hrs.  I had never previously realised that OJ could trigger migraines.

Fiona

I
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Avatar_n_tn
Thanks for your reply & suggestions. I don't have migrains per se, more constant tight pressure "tension headaches" that are 24/7. Feels like I have a tight band around my forehead. My MD sent me for physical therapy, cranial sacral, acupuncture & I have a TENS unit. None of which helped, hence why he wants me to have the ablation.
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186737_tn?1269888260
I don't know the safety or efficacy of the ablation for tension headaches, sounds scary to me, especially for nerves round the head. But, I was wondering, with all of the drugs that have been tried, if fioricet, (the combination of butalbital, acetaminophen, and caffeine) has been tried. I used to have really bad tension headaches that would go on for days to weeks to where I would walk around with my arms wrapped around my head because any jarring movement would be really bad and my doctor at the time prescribed those pills to me. For me, they worked wonders. Once a tension headache would set in it was impossible to get rid of, but after a couple of doses of fioricet, the headache would let up and go away. then I would be fine for many days until the next one would set in. Then I'd take the pills again and it would go away.
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Avatar_n_tn
Hi Kim,
I wanted to let you know that I had multiple cervical radiofrequencies usually a year  apart because thats how long the pain relief lasts for me.  I will be honest and tell you the recovery period is long and brutally painful. The worst of the pain is the first week which passes in a haze because the pain is REALLY BAD. After that it tapers off to soreness and then blessed relief in a about a months time. The radiofrequncy completely stops my severe "neck headaches". I can then go off all meds and live a normal pain free life. After a little over a years time the pain comes back thus the need to do it all over again. I do know people for whom the recovery period was just to painful for them and they elected not to have another done but for me having all that time with no pain and no debilitating headaches makes it worth it. Just make sure your Dr. does a facet injection before having RF done. RF is way to extreme a thing to try without knowing it will help. When you have the facet injection done if you get no pain relief then RF will not help and DO NOT let them do it. If you do get pain relief (even though it will be short lived) its a very good indicator that you will do well with a radiofrequency. Also, if your headaches come from the top of the neck, the occipital nerve, a pulsed radiofrequency may work for you and is MUCH MUCH less painful, has little recovery time and is very effective.
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Avatar_n_tn
Thanks for your input, I sent you a note on Med Help.
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Avatar_n_tn
Hi

I am thinking you sent me a reply in error about the med you took Fioricet.  I have not taken this med.

Interestingly, I just this past wkend had a conversation with a friend/neighbor whose specialty is Occupational medicine.  She noticed how I was hunched over in pain after sitting on the patio for an hr with her.  She asked if I had considered a facet block for my back/neck pain.  I had not.  She is getting me more information and some articles.  If there is anything interesting I will post.  She said that if the temporary block works then it generally indicates a good success if you do the ablation.  She told me that the success rate was high, only because they screen very carefully for good ablation candidates.  Also that the nerve innervation to the facet joint is direct and if ablated it does not impede motor function.

Hope that helps.  I read back through the posts of others and was a little bothered by the fact that most people say the facet block ablation procedure is REALLY painful. I will have to ask my friend exactly how painful it is during recovery :-)

Best wishes and I hope you get some relief soon.

Fiona
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Avatar_n_tn
Yes, pardon me, it was another MH member re:Fiorocet. Thanks for your informatve post about Facet blocks. With a mild sedative, they really didn't hurt, more like pressure & a small sting. The ablation did hurt a bit but not to the point of unbareable.  

Glad to hear that your friend said the success rate was high. Can you pls ask her how long after ablation one can expect results? The blocks results are instantaneous, albeit transient if their effective.

Thanks

Kim
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Avatar_f_tn
I would like to more about your experience with the radio frequency ablation.  So it sounds like you are in really bad pain for about a week after?  How bad??? What happened after the first week?  Did the doctor say to expect this and isn't there anything they can do to relieve the pain during this transition?

I had a facet block done C2, C3 several months ago and it gave me some relief but I still got headaches but now it has worn off and my doctor suggested the RFA.  They will do a "remedial nerve branch block" as a test first.

I just want to be as informed as I can.

Thanks.

Susan/Colorado
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Avatar_n_tn
Hello There :)
Subdoo I am so sorry it has taken me so long to answer your post. I have been wanting to get to talk to you too Kim, I am scheduled for this years RF on the 23rd and have been in so much pain between the neck and the headaches that I havent been online. So please accept my apologies.
ok Subdoo....Yes the worst of the pain lasts a week. The second week there is still pain but better, by the 3rd week it really is just sore, not bad at all. Even at a month out when the pain and soreness are gone there is kind of a "creepy crawly feeling"  when you touch the area or for example brush your hair. It isnt painful at all just wierd. That does go away though. ok for question number 2 pain is so subjective I don't know how to answer it but I can tell you the little sheet of paper they give you to take home that says "mild soreness" is a big ol lie :) My Dr was very honest with me the first time I had it done and said "Im gonna hurt ya...Im gonna hurt ya bad but you will be glad I did it" and he was right. I guess all I can do is give a description of the pain and that is one of intense burning. Just like when you burn your skin only it is inside your body and on a nerve so it sure isnt pleasant. The good news for you is having 2 levels done is less painful than when they have to do the whole neck. I can not express this to you strongly enough, talk to your Dr beforehand and make sure he is willing to prescribe you adequately strong pain meds for the first couple of weeks after the procedure. My Dr gives me Percocet and Neurontin for post procedure pain and he writes the Percocet for 1 or 2 as needed because there are times when 1 just isnt enough. It is really important to have something like Neurontin, Lyrica, Gabitril etc. to take along with the pain pills because they will help you get better faster. Ice is also really important..use it 20 minutes several times a day. You will have just had a burn so the ice not only helps the pain but also cuts down on inflammation....make ice your good good friend lol After my 2nd RF I didnt ice and omg was that a harsh lesson!
I am wondering why your Dr wants to put you through another procedure as a test because as I understand it if a facet injection helps an Rf will help. I would ask him if that other procedure is necessary. Im not a Dr and he is so Im sure he has a reason but it never hurts to get an explanation. I know a lot of people ( ok... 4 people i guess that isnt a lot )who have had this done and no one has had to get the remedial branch nerve block after they have had a successful facet injection before they could move on to RF.
Are they doing the C2 and C3 on both sides or just one? I hope i have answered your questions, I am not near at my best at the moment but please let me know if you have any other questions and how you are doing. I will be checking my messages until Monday the 23rd when I have my RF after that I will be M.I.A. for a couple of weeks recovering.
My Best Wishes to You,
Bonnie












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Avatar_f_tn
I have some more questions about radio frequency ablation - I'm going to the surgeon TOMORROW, Friday June 20th!!!!

1.  Kim - your post of June 10 indicates you had an ablation?  What kind?  Sounds like you didn't have the same painful experience as BonMar?  Can you tell me more about your experience and what was the reason you had the ablation?  Did it relieve your pain for the long term?

2.  BonMar - Your post on June 8 refers to a "pulsed" radio frequency ablation.  That's different than a radio frequency ablation?  If so, how?

3.  It sounds like they can do radio frequency ablation on different nerves and depending on how many and where will determine pain level aferward.   True?  

I don't know what I'll end up getting; that's what I'll be discussing with the doctor/surgeon tomorrow.  When I had the facet block done I had it done to C2 C3, both sides of neck.  But I still had headaches but decreased intensity.  But last few weeks I've been completely miserable with lots of migraines/tension headaches.  I have been using mainly icepacks to relieve pain.   So maybe the facet block did some good but perhaps RFA may be better.

I have a page of questions for the surgeon, and by communicating with others, I am becoming more educated and more questions arise, which is good so I'm more informed!  Thank you so much for all the info!!!  

Susan/Colorado
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Avatar_n_tn
Sub, can you describe your symptoms in detail? I'm curious what your experiencing & for how long.  I'll try to respond to your email but I have to go out so it may  be over the weekend. Good luck tommorow.
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Avatar_n_tn
EEK! I hope you get this before your appointment.
ok for question 2. A pulsed radiofrequency is way less painful than radiofrequency but I have only had the occipital nerve pulsed. I dont know if they can do that in the facet area. Its a good question to ask your Dr. When they do a pulsed RF they are just giving it pulses of heat to try and disrupt the pain signals rather than the full on burn they do in RF. It is a far simpler and the recovery is much less painful. In fact it really isnt too bad at all and it doesnt require anything stronger than your normal pain meds. Recovery from pulsed is only about a week and after the first day its eases more and more.
3. Before my disc disease got so bad I also had the C2 and C3 done on both sides and it is much less painful than when you get the entire neck done. Unfortunately they cant do top to bottom on both sides at once I guess it was giving people really nasty side effects so I had the right side done and am going in for the left on Monday.
so yes it is true the amount of pain depends on the levels and the amount done. The higher up the neck they go the worse the pain is what my Dr said but I have never had it done when the top discs werent involved so I dont know what say a C3 and
C4 alone would feel like.
I wish you much luck tomorrow and hope all goes well for you!!!!!!! Let me know how you are doing...and take care!
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Avatar_f_tn
Went to the surgeon yesterday, Friday.  Talked things over.  Doing a temporary remedial branch block would not tell us much because it would only last a few hours and if I wasn't having pain during that period we wouldn't be able to tell if a RFA would work in that area.

After an extensive discussion of my headache history and where the pain originates, thhe surgeon/doctor decided to do another facet block on C2/C3, both sides and also put some of the steroid on the outside of the facet joint where the occipital nerve passes over.  (I'm not quite sure of the medical term of that part).  The reason for the application of steroid to treat the occipital nerve is that when I go to physical therpay (PT) or massage, my muscles are always very constricted/tight/sore and hurt under suboccipital area (again, not quite sure of the  correct anatomical description).  

So the next steps are to see how I feel after yesterdays treatment.  I may need to go back to PT for a while, depending on how I feel.  After the last facet block I had PT twice a week for two months and it really helped.   But I've gone to PT on and off for years and the pain and muscle tightness just keeps on coming back even though I do the exercises they teach me.    I will get back with the surgeon sometime in August to discuss my progress and see whether or not an RFA is needed for long term relief.

After I came home yesterday I felt really good. :)  But by bedtime the local anesthetic had worn off and I felt like I had a pulled muscle on the right side of my neck and it hurt pretty bad. But no headache. Then I woke up in the middle of the night with a level 8  migraine on a pain scale of 1-10, my entire head was on fire.  But I don't know if it was from (1) the facet block (2) went out to eat maybe a reaction to something in the food (3) menstrual period.  So I took an Imitrex in the middle of the night and I don't think it helped much.  Then this morning took Toradol injection and am feeling quite a bit better now, mainly have the pain in neck and a moderate headache.

So, I know this is kind of backwards chronolocigally, but here's my story and how I got to this point.  I have been having migraine headaches for 20 years.  They've been severe for the past 10 years and for the past 7 or so years daily migraine/tension mixed headaches.  You name it I've tried it.  Acupuncture, chiro, PT, doctors, Diamond Headache Clinic.  I've been on all kinds of meds from Elavil, Indocin, calcium channel blockers, Topamax, Inderal, depakote, Lyrica, nardil, various antidepressants.  Am now on nimodipine, doxepine, zonegran, and nemenda as preventatives.  That's it in a nutshell!

BonMar, sounds like you have some kind of disc disease, not headaches?  Either way, I hope all goes well for you and I look forward to hearing from you again in the future!
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Avatar_n_tn
Obligatory 2 month Bump :D
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A related discussion, greater occipital pulsed radiofrequency was started.
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A related discussion, What's next after an RFA and still in pain? was started.
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A related discussion, Need input from ya all was started.
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