Safety and Efficacy of Radiofrequency Ablation and Epidural Steroid Injection for Management of Cervicogenic Headaches and Neck Pain: Meta-Analysis and Literature Review

Cureus. 2023 Feb 13;15(2):e34932. doi: 10.7759/cureus.34932. eCollection 2023 Feb.


Dysfunction of the cervical spine and its anatomical features, mostly innervated by the C1, C2, and C3 spinal nerves, can result in a secondary headache known as cervicogenic headache (CHA), mainly characterized by unilateral pain. The usefulness of pharmaceutical medications and physical therapy is currently the subject of scant literature. Interventional pain management techniques can be applied when conservative treatment is unsuccessful. This study looks at radiofrequency ablation (RFA) and epidural steroid injection (ESI) to identify their safety and efficacy in managing patients with cervicogenic headaches and neck pain. Three databases - PubMed, Cochrane CENTRAL Library, and Embase were searched, and 110 studies were identified. Nine screening processes were included for review and meta-analysis. Statistical evaluation was conducted through STATA version 17 (College Station, TX: StataCorp LLC) and effect measures were reported through random effects model risk ratios. The main subject of focus included three following outcomes: incidences of pain relief, degree and duration of pain, and incidences of adverse effects. The findings showed both interventions relieved pain by a factor of >50%, demonstrating a relative effects risk ratio of 1.45 (-0.50, 3.39) for RFA: pain relief, 84.76 (82.82, 86.69) RFA: adverse effects, and 19.46 (18.80, 20.11) ESI: pain relief at 95% confidence interval. The efficacy of RFA and ESI differ. Both interventions are effective in the reduction of cervicogenic headache pain intensity. However, their complication rates and pain duration are considerably different. With ESI, the headaches can still recur weekly, demanding the use of oral analgesics to deal with them. On the other hand, RFA has a low complication rate. Improving guidance from imaging technologies, RFA has the potential to be the most effective interventional treatment.

Keywords: cervicogenic headache; epidural steroid injection; headache; neck pain; radio-frequency ablation.

Publication types

  • Review