• radiofrequency
• neurotomy

In reading the study by Govind and colleagues,¹ in which they report the findings of an unblinded, uncontrolled, non-randomised trial of radiofrequency neurotomy for the treatment of third occipital headache, we are surprised that the authors advocate this therapy.

The last statement of the abstract is: “No other form of treatment has been validated for this common form of headache”. This implies that Govind et al believe they have validated radiofrequency neurotomy as a form of treatment of third occipital headache. Presumably they are prepared, given the apparently impressive numbers of responders, to forego the usual practice of placebo controlled trial.

We do not understand how the authors can expect this treatment to be realistically adopted in clinical practice with no attempt to validate it the way treatments are meant to be validated, through randomised, placebo controlled trials. The statement in their final paragraph that “some practitioners may be averse to implementing a treatment that requires repetition” could perhaps more appropriately state that “some practitioners may be averse to implementing a treatment that remains unvalidated”.

The authors state that one reason they did not do a placebo controlled study is that a previous study has already validated this technique in other patients.² That a …