title: Systematic review of radiofrequency ablation and pulsed radiofrequency for management of cervicogenic headache.
abstract: BACKGROUND
  Cervicogenic headache is a secondary headache that has a source in the upper cervical spine. There is a small but growing body of evidence to establish effectiveness of radiofrequency (RF) neurotomy, and the pulsed RF (PRF) procedure for management of cervicogenic headache.
  
  
  OBJECTIVE
  To investigate the clinical utility of RF neurotomy, and PRF ablation for the management of cervicogenic headache.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  The review included relevant literature identified through searches of PubMed, Cochrane, Clinical trials, U.S. National Guideline Clearinghouse and EMBASE from 1960 to January 2014.The quality assessment and clinical relevance criteria utilized were the Cochrane Musculoskeletal Review Group criteria for randomized control trials and the Newcastle-Ottawa Scale criteria for observational studies. The level of evidence was classified as good, fair, and poor based on the quality of evidence.
  
  
  METHODS
  The primary outcome measures were reduction in pain scores and improvement in quality of life.
  
  
  RESULTS
  The primary outcome measures were headache relief and improved quality of life. Twenty five studies were identified for full text review of these, 9 studies met inclusion criteria. There were 5 non-randomized, among them 4/5 were of moderate quality, 3/5 showed RF ablation and 1/5 showed PRF as an effective intervention for cervicogenic headache. There were 4 randomized trials among them 2/4 were of high quality, 3/4 investigated RF ablation as an intervention for CHA, 1/4 investigated PRF ablation as an intervention for CHA and none of the randomized studies showed strong evidence for RF and PRF ablation as an effective intervention for CHA.
  
  
  CONCLUSIONS
  In the selected studies there were inconsistencies between randomized trials, flaws in trial design, and gaps in the chain of evidence.
  
  
  CONCLUSIONS
  There is limited evidence to support RF ablation for management of CHA as there are no high quality RCTs and/ or multiple consistent non-RCTs without methodological flaws. There is poor evidence to support PRF for CHA as there are no high quality RCTs or Non-RCTs.
authors: Vittal R
authors: VR
authors: Nagar
authors: Pravardhan
authors: P
authors: Birthi
authors: Jay S
authors: JS
authors: Grider
authors: Department of Physical Medicine and Rehabilitation, University of Kentucky College of Medicine, Lexington, KY, Saint Francis Medical Center, Grand Island, Nebraska, Department of Anesthesiology, University of Kentucky College of Medicine, Lexington, KY;
authors: Amit
authors: A
authors: Asopa
mesh_terms: D017115:Catheter Ablation / Q000379:methods*; D019468:Disease Management; D006801:Humans; D051298:Post-Traumatic Headache / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D061208:Pulsed Radiofrequency Treatment / Q000379:methods*; D011788:Quality of Life / Q000523:psychology; D016032:Randomized Controlled Trials as Topic / Q000379:methods