Cryoanalgesia to Treat Chronic Daily Headaches and Migraines
Cryoanalgesia shows mixed results in management of headache-related pain
Pharmacologic therapies are often ineffective in treating chronic daily headaches (CDH), prompting the search for alternative therapies. Anesthetic-mediated nerve block interventions have a short-term effect.
Fawad Khan, MD, founder of the Comprehensive Headache Center at Ochsner Neuroscience Institute in New Orleans, LA, presented a report on the use of cryoanalgesia for the management of CDH at this year's American Headache Society Meeting.1
In cryoanalgesia, liquid nitrogen at -190° C is applied to tissues, creating a conduction block and vascular damage around sensory nerves, but leaving the myelin sheath intact.2 This technique is used to manage pain resulting from a number of conditions, from rib fractures to post-herpetic neuralgia, and can lead to long-lasting pain relief. 2
In the report presented at AHS 2016, results from 8 cryoanalgesia interventions to treat CDH in 7 female patients (ages 23 to 76) suffering from chronic migraine, chronic cluster headache, chronic temporo-mandibular joint syndrome, or chronic cervicogenic headache were reviewed. Targeted nerves (occipital, supra-orbital or zygomato-temporal) were percutaneously frozen using a hand-held cryo-application device (Iovera, Myoscience, Inc).
Best result was achieved for 1 patient who remained pain-free for 9 days following the procedure, time after which pain returned to pre-procedure levels. 2 patients reported mild pain reduction for 4 weeks, another patient, just for 2 days. 1 other patient saw her pain reduced by half, and 3 of 6 patients with chronic migraine had overall symptom improvements. Finally, 2 patients did not experience any pain relief as a result of cryoanalgesia.
Dr Khan concludes that this intervention allows ease of use and reversible effects, and that despite the small and heterogenous sample size, this review might reveal promising results for analgesia in treating CDH in some patient subpopulations.
For additional coverage of AHS 2016, go here.
1.Khan FA. Abstract PS64. Cryoanalgesia for the Management of Chronic Daily Headache - Exploring an Office-Based Technique. Presented at: 2016 American Headache Society Annual Meeting. June 9-12, 2016; San Diego, CA.
2.Trescot AM. Cryoanalgesia in interventional pain management. Pain Physician. 2003;6(3):345-60.