title: A systematic review of peripheral nerve interventional treatments for chronic headaches.
abstract: OBJECTIVE
  This study aimed to systematically compare the outcomes of different types of interventional procedures offered for the treatment of headaches and targeted toward peripheral nerves based on available published literature.
  
  
  BACKGROUND
  Multiple procedural modalities targeted at peripheral nerves are being offered to patients for the treatment of chronic headaches. However, few resources exist to compare the effectiveness of these modalities. The objective of this study was to systematically review the literature to compare the published outcomes and effectiveness of peripheral nerve surgery, radiofrequency (RF) therapy, and peripheral nerve stimulators for chronic headaches, migraines, and occipital neuralgia.
  
  
  METHODS
  A broad literature search of the MEDLINE and CENTRAL (Cochrane) databases was undertaken. Relevant studies were selected by 2 independent reviewers and these results were narrowed further by the application of predetermined inclusion and exclusion criteria. Studies were assessed for quality, and data were extracted regarding study characteristics (study type, level of evidence, type of intervention, and number of patients) and objective outcomes (success rate, length of follow-up, and complications). Pooled analysis was performed to compare success rates and complications between modality types.
  
  
  RESULTS
  Of an initial 250 search results, 26 studies met the inclusion criteria. Of these, 14 articles studied nerve decompression, 9 studied peripheral nerve stimulation, and 3 studied RF intervention. When study populations and results were pooled, a total of 1253 patients had undergone nerve decompression with an 86% success rate, 184 patients were treated by nerve stimulation with a 68% success rate, and 131 patients were treated by RF with a 55% success rate. When compared to one another, these success rates were all statistically significantly different. Neither nerve decompression nor RF reported complications requiring a return to the operating room, whereas implantable nerve stimulators had a 31.5% rate of such complications. Minor complication rates were similar among all 3 procedures.
  
  
  CONCLUSIONS
  Of the 3 most commonly encountered interventional procedures for chronic headaches, peripheral nerve surgery via decompression of involved peripheral nerves has been the best-studied modality in terms of total number of studies, level of evidence of published studies, and length of follow-up. Reported success rates for nerve decompression or excision tend to be higher than those for peripheral nerve stimulation or for RF, although poor study quantity and quality prohibit an accurate comparative analysis. Of the 3 procedures, peripheral nerve stimulator implantation was associated with the greatest number of complications. Although peripheral nerve surgery seems to be the interventional treatment modality that is currently best supported by the literature, better controlled and normalized high-quality studies will help to better define the specific roles for each type of intervention.
authors.affiliation: From the Department of Plastic Surgery, Georgetown University Hospital, Washington, DC.
authors.forename: Ivica
authors.initials: I
authors.lastname: Ducic
authors.forename: John M
authors.initials: JM
authors.lastname: Felder
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Fantus
mesh_terms: D017115:Catheter Ablation; D019299:Decompression, Surgical; D004599:Electric Stimulation Therapy; D020773:Headache Disorders / Q000628:therapy*; D006801:Humans; D008881:Migraine Disorders / Q000628:therapy; D009437:Neuralgia / Q000628:therapy; D019635:Neurosurgical Procedures; D010525:Peripheral Nerves / Q000601:surgery*; D016896:Treatment Outcome