Abstract:

Objective To investigate the effect of high-voltage long-duration pulsed radiofrequency （HL-PRF） on the cognitive function in patients with cervicogenic headache （CEH）， and to evaluate the potential clinical value of this therapeutic modality in improving cognitive function in the CEH patients. Methods A total of 23 patients diagnosed with CEH were enrolled. All patients underwent HL-PRF therapy targeting the affected C2 dorsal root ganglion. Before treatment and at 3 months after treatment， Beijing version of Montreal Cognitive Assessment （MoCA-BJ） was used to assess the global cognitive function of the patients. Auditory Verbal Learning Test-Huashan version （AVLT-H） subscale scores （N1， N2， N3， N4， N5， N6） were used to assess the episodic memory activities of the patients. Digit span test （DST） was used to assess the attention and working memory activities of the patients. Numerical rating scale （NRS） was used to assess the pain intensities of the patients. Visual analogue scale （VAS） for dizziness was used to assess the dizziness severities of the patients. Doppler ultrasonography was used to record the blood flow parameters of the ipsilateral C1 segment vertebral artery of the patients before treatment， immediately after treatment， and at 1 week， 1 month， and 3 months after treatment， including time-averaged mean velocity （Vm）， peak systolic velocity （PSV）， minimum velocity （Vmin）， resistance index （RI）， and pulsatility index （PI）. Pearson correlation coefficient analysis or Spearman correlation coefficient analysis was used to evaluate the correlations between the changes in pain and dizziness scores and the changes in cognitive test scores of the patients. Results The MoCA-BJ scores and DST scores at 3 months after treatment in the patients showed no statistically significant differences compared with those before treatment （P>0.05）， while all AVLT-H subscale scores were significantly increased in the patients （P<0.05）. The NRS score at 3 months after treatment was significantly decreased in the patients compared with that before treatment （P<0.001）， while VAS score for dizziness showed no statistically significant difference （P>0.05）. The Vm， PSV， and Vmin of the ipsilateral C1 segment vertebral artery of the patients immediately after treatment were significantly increased compared with those before treatment （P<0.05 or P<0.001）， while the PI and RI showed no statistically significant differences （P>0.05）. No statistically significant differences were observed in the above blood flow parameters of the patients at 1 week， 1 month， and 3 months after treatment compared with those before treatment （P>0.05）. Correlation analysis results showed that the change in VAS score for dizziness was negatively correlated with the change in AVLT-H subscale N3 score （r=-0.466， P<0.05）. Conclusion HL-PRF effectively alleviates the pain in the CEH patients， improves their performance in specific cognitive domains （e.g.， episodic memory）， and induces transient improvements in vertebral artery hemodynamics in the early period after treatment. The relief of dizziness symptoms is correlated with the improvement in certain memory function indicators.

Key words: Cervicogenic headache, High-voltage long-duration pulsed radiofrequency, Cognitive function, Vertebral artery, Dizziness