Abstract
Objective. The aim of this study was to compare the efficacy of ultrasound-guided deep cervical plexus block with fluoroscopy-guided deep cervical plexus block for patients with cervicogenic headache (CeH). Methods. A total of 56 patients with CeH were recruited and randomly assigned to either the ultrasound-guided (US) or the fluoroscopy-guided (FL) injection group. A mixture of 2–4 mL 1% lidocaine and 7 mg betamethasone was injected along C2 and/or C3 transverse process. The measurement of pain was evaluated by patients' ratings of a 10-point numerical pain scale (NPS) before and 2 wks, 12 wks, and 24 wks after treatments. Results. The blocking procedures were well tolerated. The pain intensity, as measured by NPS, significantly decreased at 2 wks after injection treatment in both US and FL groups, respectively, compared with that of baseline (P < 0.05). The blocking procedures had continued, and comparable pain relieving effects appeared at 12 wks and 24 wks after treatment in both US and FL groups. There were no significant differences observed in the NPS before and 2 wks, 12 wks, and 24 wks after treatment between US and FL groups. Conclusions. The US-guided approach showed similar satisfactory effect as the FL-guided block. Ultrasonography can be an alternative method for its convenience and efficacy in deep cervical plexus block for CeH patients without radiation exposure.
Highlights
Cervicogenic headache (CeH) is a common diagnosis for patients with unilateral referred pain to the head from the upper cervical spine [1]
US or FL-guided C2 and/or C3 transverse process steroid injections were applied to 54 patients with CeH and comparable pain relief effect was observed
It has been frequently demonstrated that blockade of the greater occipital nerve, the lesser occipital nerve, the stellate ganglion, and other various blocking treatments are effective strategies for CeH
Summary
Cervicogenic headache (CeH) is a common diagnosis for patients with unilateral referred pain to the head from the upper cervical spine [1]. Treatment strategies for CeH are wide and varied, such as medication, physical therapy, acupuncture, manipulation, transcutaneous electrical nerve stimulation, pulsed radiorefrequency, injections, and surgery [3, 4]. The majority of patients preferred to choose the noninvasive strategies, including physical and manual therapies, activity modification, and various medication trials before considering anesthetic blocks [1, 2, 5,6,7]. Ultrasound-guided injections have been described recently in the literatures, and the absence of radiation exposure, equipment affordability, and bedside setting are advantages of ultrasonography compared with traditional radiological imaging [15,16,17,18]
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