title: Treatment of hemicrania continua with radiofrequency ablation and long-term follow-up.
abstract: OBJECTIVE
  The objective of this research is to describe novel procedural treatments for hemicrania continua that allow patients to remain off indomethacin.
  
  
  METHODS
  Case reports are presented.
  
  
  RESULTS
  We describe four distinct patients with indomethacin-responsive hemicrania continua who were unable to discontinue the use of indomethacin without headache recurrence. No other medications were effective for their syndrome. Secondary causes of headache were ruled out in each case. Each patient underwent diagnostic blockade of either the atlanto-axial joint, C2 dorsal root ganglion or sphenopalantine ganglion depending on their clinical examination and presence of cranial autonomic symptoms. A positive response led to a radiofrequency ablation of the C2 ventral ramus, C2 dorsal root ganglion or sphenopalantine ganglion, which provided headache relief in all case patients as complete as indomethacin. Long-term follow-up of these patients has shown that all have remained essentially headache free without the need for indomethacin. One patient has needed repeat radiofrequency procedures with consistent response.
  
  
  CONCLUSIONS
  Hemicrania continua is defined by its sensitivity to indomethacin but very few patients are able to discontinue the medication without headache recurrence. As the risks of chronic indomethacin use are substantial, alternative treatments are necessary to protect patient health. We are now able to suggest several radiofrequency ablation procedures as effective as indomethacin with long-term follow-up.
authors.affiliation: Geisinger Headache Center, Department of Neurology, Geisinger Health System, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Beams
authors.affiliation: Private Practice Interventional Pain Management, USA.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Kline
authors.affiliation: Geisinger Headache Center, Department of Neurology, Geisinger Health System, USA tdrozmigraine@yahoo.com.
authors.forename: Todd D
authors.initials: TD
authors.lastname: Rozen
mesh_terms: D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007213:Indomethacin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000175:diagnosis* / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D007213:Indomethacin
keywords: Hemicrania continua; anesthesiologic blockade; indomethacin; neuro-stimulator; radiofrequency ablation