Evidence-Based Patient Selection in Headache Surgery: The Impact of Preoperative RFA Treatment on Surgical Outcomes.

BACKGROUND: Radiofrequency ablation (RFA) of the greater occipital nerve (GON) is a minimally- invasive treatment option commonly used in patients with occipital neuralgia. Patients who undergo occipital surgery for headaches after failed RFA treatment present a unique opportunity to evaluate RFA- treated occipital nerves and determine the impact on headache surgery outcomes.

METHODS: Of 115 patients who underwent headache surgery at the occipital site, twenty- nine had a history of prior RFA treatment. Migraine Headache Index, Pain Self- Efficacy Questionnaire, and Pain Health Questionnaire- 2 outcome scores were recorded preoperatively and at follow- up visits. Intraoperative macroscopic nerve damage and surgical outcomes were compared between RFA and non- RFA patients.

RESULTS: RFA- treated patients had a higher rate of macroscopic nerve damage (45%) than non RFA- treated patients (24%) (p= 0.03), and were significantly more likely to require a second surgery at the site of primary decompression (27.6% versus 5.8%; p= 0.001), as well as GON transection (13.8% versus 3.5%; p= 0.04). Outcome scores at the last follow up visit showed no statistically significant difference between RFA- treated and non RFA- treated patients (p= 0.96).

CONCLUSION: RFA patients can ultimately achieve outcomes that are not significantly different from non- RFA patients in occipital headache surgery. However, a higher number of secondary surgery at the site of primary decompression and nerve transections are required to treat refractory symptoms. RFA- treated patients should be counselled about an increased risk of same-site surgery and possible GON transection to achieve acceptable outcomes.