Introduction Headaches are among the most prevalent and disabling sources of pain, affecting nearly half of adults worldwide. Many patients experience debilitating headaches refractory to conservative treatments, including pharmacotherapy, steroid injections, or other interventional therapies. Radiofrequency ablation (RFA) is a minimally invasive technique that uses controlled thermal energy to create targeted tissue necrosis, disrupting the nociceptive signaling within targeted sensory nerves, and is a promising therapy for patients with chronic headaches refractory to conservative treatments. The objective of this study is to evaluate the clinical efficacy of thermal RFA for chronic headache management by examining changes in pain scores and the duration and degree of symptom relief. Methods This retrospective chart review of this study investigates patients who received thermal RFA of the occipital, supraorbital, supratrochlear, infraorbital, infratrochlear, and/or anterior ethmoid nerves between 2015 and 2025. Preoperative and postoperative pain scores were assessed using the Visual Analogue Scale (VAS). Additionally, the duration of relief and any adverse events associated with the procedures were recorded. Paired t-tests were performed between preoperative and postoperative VAS pain scores to determine statistical significance, with a p-value of ≤ 0.05 denoting significance. Results In total, 940 procedures were reviewed; 108 were excluded, and 832 procedures from 464 patients were included. The 464 patients comprised 369 female and 95 male patients, with a mean age of 44.83 ± 15.99 years and body mass index (BMI) of 29.65 ± 7.44 kg/m². Average preoperative and postoperative VAS scores were 5.34 ± 2.01 and 3.04 ± 2.33, respectively, representing a statistically significant reduction (p < 0.001). Quantitative or qualitative improvement was reported in 68.63% of procedures, and 13.10% noted complete remission for a total of 81.73% experiencing pain relief, whereas 18.27% saw no change. Among effective cases, the mean improvement was 60.20 ± 28.54%, lasting an average of 7.47 ± 9.78 months. A total of 12 adverse events were reported. Conclusions These findings suggest that thermal RFA of pericranial nerves can offer meaningful, lasting relief for patients with neuralgic headaches that resist traditional treatments. As a minimally invasive option with limited side effects, RFA may reduce the need for ongoing pharmacologic management and improve the quality of life for chronic headache sufferers.

Introduction Chronic pain poses a significant challenge to quality of life throughout the USA. It is estimated that as much as 21% of the US population experiences chronic pain, and the incidence of new chronic pain cases is shockingly high, at 52.4 cases per 1000 persons per year. An intrathecal pump (ITP) consists of a small pump surgically implanted under the skin, along with a catheter inserted into the intrathecal space in the spine. Medication, usually in the form of opioids, local anesthetics, or muscle relaxants, is then delivered through the catheter into the spinal fluid, where it can act directly on nerves to provide pain relief or reduce spasticity. The use of intrathecal drug delivery has been established for decades and is used for various conditions, including chronic noncancer pain and cancer-related pain. ITPs are also employed for managing severe spasticity in conditions such as multiple sclerosis or spinal cord injury. Over the years, there has been a gradual increase in the use of ITPs, particularly as awareness of their benefits and technological advancements has increased. ITPs have been historically placed in the abdomen. However, more recently, some ITPs have begun to be placed in the lower back. Placing ITPs in the lower back has the potential to lower operative time and complication rates, but more research in this area is warranted. This study analyzes the outcomes of posterior ITP placement to evaluate their suitability and potential benefits. Methods This study consisted of a retrospective review including data from 115 procedures completed between 2015 and 2025. Data collection included patient demographics, preoperative and postoperative pain scores, surgical time, needle and catheter locations, and adverse events. Pain scores were collected using the visual analog scale (VAS), and data were analyzed using SPSS 29. Two-tailed paired t-tests were used to determine the significance of the difference between preoperative and postoperative pain scores. Results A total of 115 procedures from 103 patients were included in the statistical analysis. The average preoperative pain was 6.54 (6.54 ± 2.00, n = 114), and the average postoperative pain score in the first year following the procedure was 4.45 (4.45 ± 2.30, n = 114), with a p value of < 0.001. The average surgical time for the procedure was 49.00 ± 19.53 min (n = 113). Conclusions In this study, ITPs implanted in the lower back were associated with greater pain relief, shorter surgical times, and fewer complications than those placed in the abdomen. These findings, while indirect, provide evidence for promoting ITP placement in the lower back as a safe and effective option for patients experiencing chronic pain.

Background: Neurovascular compression syndromes (NVCS) represent a spectrum of disabling neurologic disorders caused by vascular or structural compression of cranial nerves, most commonly at the root entry zone. Conditions such as trigeminal neuralgia (TN), hemifacial spasm (HFS), and glossopharyngeal neuralgia (GN) are associated with significant pain, functional impairment, and reduced quality of life. This review provides a multidisciplinary, anatomically grounded overview of the pathophysiology, diagnosis, imaging, and contemporary management strategies for NVCS. Methods: A narrative review of the literature was conducted, synthesizing historical perspectives, neuroanatomy of the cerebellopontine angle, mechanisms of neurovascular conflict, advances in imaging and neuromonitoring, and current treatment modalities. Medical, percutaneous, surgical, radiosurgical, and neuromodulatory approaches were evaluated, with emphasis on patient selection and outcome considerations. Results: Neurovascular compression, most frequently arterial compression at the root entry zone, leads to focal demyelination, ephaptic transmission, and neuronal hyperexcitability. High-resolution Magnetic resonance imagin (MRI) remains the diagnostic gold standard. First-line management for TN and related syndromes typically includes pharmacotherapy, particularly sodium channel blockers. Refractory cases may benefit from percutaneous rhizotomy, balloon compression, stereotactic radiosurgery, or microvascular decompression (MVD), which offers the most durable relief in appropriately selected patients. Emerging technologies, including endoscopic visualization, advanced neuromodulation, and virtual reality-assisted surgical planning, continue to refine treatment precision and safety. Conclusions: Effective management of NVCS requires a comprehensive understanding of neuroanatomy, pathogenesis, and individualized risk–benefit profiles. A multidisciplinary, stepwise approach optimizes outcomes and improves quality of life in patients with these complex disorders.

1. Neuropathy is a debilitating condition caused by damage to the peripheral nerves. Approximately 1% of adults worldwide are affected, with prevalence higher among those aged 60 and older. Periphe...