Cervicogenic Headache and Neck Pain: Cervical Facet Radiofrequency Ablation

That sits outside pain medicine. It belongs to cardiology and gastroenterology. This practice does not treat visceral pain originating from the heart or lungs and stays restricted to musculoskeletal and neuropathic pain.

Under international Spine Society guidelines, when the primary problem is pain alone, the patient does not need surgery, regardless of the degree of compression shown on imaging, as long as it is below L2. Surgery is indicated for disability: foot drop, motor deficit, sensory deficit, or more than moderate to severe canal stenosis on MRI, where an intervention can only buy time rather than treat the underlying disease. At Artemis, pain medicine and spine surgery work as a team. If a patient referred for pain turns out to have a neurological deficit, they go straight to the spine surgeon; if pain is the only presenting symptom, pain medicine treats it. The line between the two is clear.

If the femoral head itself is involved, radiofrequency ablation of the hip joint, targeting the genicular nerves supplying the joint, is a very rewarding procedure. But if the pain originates from the bone itself or has a visceral component, high-dose NSAIDs risk the kidneys and the better approach is opioid-based: morphine or tramadol with paracetamol and a neuropathic agent, alongside any specific interventional target that exists.

That is not something done from pain medicine. Deep brain stimulation is coming up fast as a field, but at Artemis it sits with the neurosurgery team, not pain medicine. That question is better asked at a neurosurgery masterclass.

First establish whether it is lateral or central canal stenosis, and check for any sensory or motor deficit on examination. Without a deficit and with lateral canal stenosis, transforaminal epidural adhesiolysis gives wonderful results. With moderate to severe central stenosis, a real sensory or motor deficit, and pain that does not respond to a block, the patient needs surgery.

Around 70%, by Dr. Jain's estimate, arising from the C2-C3 nerves. This pattern is called cervicogenic headache.

By stimulating the nerve, for example C2, and confirming the patient's pain reproduces in the expected referral pattern, such as radiating to the occipital area, before proceeding to ablation.

Yes. Radiofrequency ablation from C2 to C6 in a single sitting can address cervicogenic headache, neck pain, shoulder pain and scapular pain together, since they often share the same cervical facet source.