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Cervicogenic Headache
Bogduk N.
Posted: February 2006  
Cephalalgia 2004;24:819-820

The paradigm of radiofrequency medial branch neurotomy does not allow for partial responses. If a patientís pain arises from a zygapophysial joint of the neck, anaesthetizing that joint should provide complete relief of their pain. If the pain arises from more than one joint, anaesthetizing only one of these joints will provide partial or no relief, but anaesthetizing all of the symptomatic joints should provide complete relief of pain.

Alternatives are not feasible. It is peculiar therefore that in their study, Stovner et al. expected to be able to relieve cervicogenic headache. The clinical criteria that they used have not been validated against the criterion standard of complete relief of pain. Moreover, even though response to blocks was not used as a criterion in their study, blocks were nevertheless performed. No patient obtained complete relief. Therefore, no patient could be expected to obtain relief from radiofrequency denervation. Yet they were enrolled in a controlled trial. Under those conditions, the trial was destined to show no efficacy. Therefor, the study of Stovner et al. cannot be taken as an indictment of zygapophysial joint blocks or of medial branch neurotomy.