Comparison of the efficacy of repeated greater occipital nerve block and pulsed radiofrequency therapy in chronic migraine patients: a randomized controlled study

The aim of this study was to compare the effectiveness of greater occipital nerve (GON) block and pulsed radiofrequency (PRF) treatment in chronic migraine patients. Seventy patients admitted to the Neurology and Algology outpatient clinic between September 2023 and December 2023 and diagnosed with chronic migraine according to The International Classification of Headache Disorders 3rd Edition (ICHD-3) criteria were included in the study. Patients were randomized into 2 groups to receive ultrasound-guided repeated GON block and PRF. Visual Analog Scale (VAS) scores for pain relief and Migraine Disability Assessment (MIDAS) scores for disability were recorded before the procedure and at 1st and 6th months after the procedure. In both groups, 35 patients with greater occipital nerve (GON) block, 32 patients with GON PRF, the pain scores at 1st and 6th months post-procedure were significantly lower compared to before the procedure (p < 0.001, p < 0.001, respectively). VAS scores were significantly lower in the PRF group than in the GON block group at 6th month (p = 0.009). In both groups, post-procedural MIDAS scores at 1st and 6th months were significantly lower compared to before the procedure (p < 0.001, p < 0.001, respectively). In the GON PRF group, MIDAS scores at 6th month were significantly lower than MIDAS scores at 1st month (p < 0.001). MIDAS scores were significantly lower in the PRF group compared to the GON block group at 6th months (p < 0.001).Interventional procedures such as GON block and PRF are safe and effective methods in chronic migraine. PRF is a better alternative to GON block in chronic migraine with longer effectiveness.

Chronic migraine; Greater occipital nerve; Pulsed radiofrequency; Nerve blocks; Ultrasound guided injection

[1] Stewart WF, Wood C, Reed ML, Roy J, Lipton RB; AMPP Advisory Group. Cumulative lifetime migraine incidence in women and men. Cephalalgia. 2008; 28: 1170–1178.

[2] Headache Classification Committee of the International Headache Society. HS Classification Definition of Terms. The International Classification of headache disorders. 3rd edn. Sage Publications Ltd: London, UK. 2018.

[3] Buse DC, Manack AN, Fanning KM, Serrano D, Reed ML, Turkel CC, et al. Chronic migraine prevalence, disability, and sociodemographic factors: results from the American migraine prevalence and prevention study. Headache. 2012; 52: 1456–1470.

[4] Piovesan EJ, Werneck LC, Kowacs PA, Tatsui CE, Lange MC, Vincent M. Anesthetic blockade of the greater occipital nerve in migraine prophylaxis. Arquivos de Neuro-Psiquiatria. 2001; 59: 545–551. (In Portuguese)

[5] Dilli E, Halker R, Vargas B, Hentz J, Radam T, Rogers R, et al. Occipital nerve block for the short-term preventive treatment of migraine: a randomized, double-blinded, placebo-controlled study. Cephalalgia. 2015; 35: 959–968.

[6] Flamer D, Alakkad H, Soneji N, Tumber P, Peng P, Kara J, et al. Comparison of two ultrasoundguided techniques for greater occipital nerve injections in chronic migraine: a double-blind, randomized, controlled trial. Regional Anesthesia & Pain Medicine. 2019; 44: 595–603.

[7] Inan LE, Inan N, Karadaş Ö, Gül HL, Erdemoğlu AK, Türkel Y, et al. Greater occipital nerve blockade for the treatment of chronic migraine: a randomized, multicenter, double-blind, and placebo-controlled study. Acta Neurologica Scandinavica. 2015; 132: 270–277.

[8] Hamann W, Abou-Sherif S, Thompson S, Hall S. Pulsed radiofrequency applied to dorsal root ganglia causes a selective increase in ATF3 in small neurons. European Journal of Pain. 2006; 10: 171–176.

[9] Chua NH, Vissers KC, Sluijter ME. Pulsed radiofrequency treatment in interventional pain management: mechanisms and potential indications—a review. Acta Neurochirurgica. 2011; 153: 763–771.

[10] Sam J, Catapano M, Sahni S, Ma F, Abd-Elsayed A, Visnjevac O. Pulsed radiofrequency in interventional pain management: cellular and molecular mechanisms of action—an update and review. Pain Physician. 2021; 24: 525–532.

[11] Cohen SP, Peterlin BL, Fulton L, Neely ET, Kurihara C, Gupta A, et al. Randomized, double-blind, comparative-effectiveness study comparing pulsed radiofrequency to steroid injections for occipital neuralgia or migraine with occipital nerve tenderness. Pain. 2015; 156: 2585–2594.

[12] Batistaki C, Madi AI, Karakosta A, Kostopanagiotou G, Arvaniti C. Pulsed radiofrequency of the occipital nerves: results of a standardized protocol on chronic headache management. Anesthesia and Pain Medicine. 2021; 11: e112235.

[13] Guner D, Eyigor C. Efficacy of ultrasound-guided greater occipital nerve pulsed radiofrequency therapy in chronic refractory migraine. Acta Neurologica Belgica. 2023; 123: 191–198.

[14] Yaray O, Akesen B, Ocaklioğlu G, Aydinli U. Validation of the Turkish version of the visual analog scale spine score in patients with spinal fractures. Acta Orthopaedica et Traumatologica Turcica. 2011; 45: 353–358.

[15] Ertaş M, Siva A, Dalkara T, Uzuner N, Dora B, Inan L, et al. Turkish MIDAS group Validity and reliability of the Turkish Migraine Disability Assessment (MIDAS) questionnaire. Headache. 2004; 44: 786–793.

[16] Perdecioğlu GRG, Ateş MP, Yürük D, Can E, Yıldız G, Akkaya ÖT. A new neuromodulation method in chronic migraine; non-ınvasive pulsed radiofrequency, a single-blinded, randomised, controlled trial. Irish Journal of Medical Science. 2024; 193: 1487–1493.

[17] Tanaka N, Yamaga M, Tateyama S, Uno T, Tsuneyoshi I, Takasaki M. The effect of pulsed radiofrequency current on mechanical allodynia induced with resiniferatoxin in rats. Anesthesia & Analgesia. 2010; 111: 784–790.

[18] Ozsoylar O, Akçali D, Cizmeci P, Babacan A, Cahana A, Bolay H. Percutaneous pulsed radiofrequency reduces mechanical allodynia in a neuropathic pain model. Anesthesia & Analgesia. 2008; 107: 1406–1411.

[19] Huang JH, Galvagno SM Jr, Hameed M, Wilkinson I, Erdek MA, Patel A, et al. Occipital nerve pulsed radiofrequency treatment: a multi-center study evaluating predictors of outcome. Pain Medicine. 2012; 13: 489–497.

[20] Abejon D, Reig E. Is pulsed radiofrequency a neuromodulation technique? Neuromodulation. 2003; 6: 1–3.

[21] Brasil LJ, Marroni N, Schemitt E, Colares J. Effects of pulsed radiofrequency on a standard model of muscle injury in rats. Anesthesia and Pain Medicine. 2020; 10: e97372.

[22] Bogduk N. Pulsed radiofrequency. Pain Medicine. 2006; 7: 396–407.