Pain-free survival after endoscopic neurotomy versus radiofrequency ablation of the C2 dorsal root ganglion for cervicogenic headache: a real-world comparison study.

Background: Cervicogenic headache (CEH) is commonly treated with radiofrequency ablation (RFA) targeting the C2 dorsal root ganglion (DRG), yet the durability of analgesia is often limited. Endoscopic neurotomy (EN) enables direct visualization of the target neural structures and may provide more sustained pain relief; however, supporting evidence remains limited. We compared long-term outcomes of EN versus RFA targeting the C2 DRG in CEH. Methods: Patients with a positive diagnostic C2 DRG block were treated with EN or RFA. The Numerical Rating Scale (NRS), EuroQol 5-Dimension 5-Level (EQ-5D-5L), and Patient Global Impression of Change (PGIC) were obtained at baseline, and at 3 and 12 months postoperatively. The pain-free duration was recorded at every follow-up. The final follow-up was conducted in January 2026. Results: Of 76 included patients, 21 underwent EN and 55 underwent RFA. Both groups demonstrated significant reductions in NRS and improvements in EQ-5D-5L at 3 and 12 months postoperatively compared with baseline ( Conclusions: In this retrospective cohort, both EN and RFA improved pain and quality of life in clinically selected patients with CEH. EN was associated with longer pain-free duration; however, given its invasiveness and the diagnostic overlap between CEH and occipital neuralgia, EN should be considered cautiously as an escalation option in carefully evaluated patients.