title: Whiplash patients with cervicogenic headache after lateral atlanto-axial joint pulsed radiofrequency treatment.
abstract: BACKGROUND
  Whiplash patients regard cervicogenic headache (CEH) as the most burdensome symptom of their condition. Sufferers experience a significant degree of disability from headache, associated neck pain and disability, and sleep disturbance. Lateral C1/2 joint pulsed radiofrequency (PRF) treatment has been shown to produce significant relief from headache in patients with CEH.
  
  
  OBJECTIVE
  The objective of this retrospective questionnaire study of 45 consecutive whiplash patients with CEH who had undergone antero-lateral atlantoaxial joint pulsed radiofrequency treatment (AA PRF) was to evaluate the treatment's long-term effects on pain-related disability and health-related quality of life.
  
  
  METHODS
  Four questionnaires were sent to all 45 patients who had undergone AA PRF: 1) The short form-36 (SF-36); 2) The neck disability index (NDI); 3) The medical outcome scale-sleep scale (MOS-SS); 4) The headache impact test-6 (HIT-6). All 45 patients received AA PRF under fluoroscopic guidance. PRF treatment was conducted at 45 V with a pulsed frequency of 4 Hz and a pulsed width of 10 ms for 4 minutes .
  
  
  RESULTS
  Patients who responded to the procedure reported lower pain scores at 2, 6, and 12 months of follow-up compared to nonresponders. More important, patients reported marked improvements in headache impact (P < 0.01), neck-disability scores (P < 0.01), awakening due to headache (P < 0.01), and sleep problems (9-item; P < 0.05) on the MOS-SS. Responders to the procedure also reported a significantly higher health-related quality of life in terms of bodily pain (P < 0.05) and health change (P < 0.01) on the SF-36.
  
  
  CONCLUSIONS
  In light of the inherent limitations of our retrospective study, AA PRF treatment can only be tentatively viewed as a promising treatment modality for whiplash patients with CEH and is subject to validation in future studies.
authors.affiliation: Department of Anesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore.
authors.forename: Nicholas Hl
authors.initials: NH
authors.lastname: Chua
authors.affiliation: Department of Anesthesiology and Pain Management, St Anna Hospital, Geldrop, The Netherlands.
authors.forename: Willy
authors.initials: W
authors.lastname: Halim
authors.affiliation: Department of Anesthesiology, Pain and Palliative Medicine, Radboud University, Nijmegen Medical Center, Nijmegen, The Netherlands.
authors.forename: Andrea Wm
authors.initials: AW
authors.lastname: Evers
authors.affiliation: Department of Anesthesiology, Pain and Palliative Medicine, Radboud University, Nijmegen Medical Center, Nijmegen, The Netherlands.
authors.forename: Kris Cp
authors.initials: KC
authors.lastname: Vissers
keywords: Atlanto-Axial Joint; Headache; Pulsed Radiofrequency Treatment; Whiplash Injury