Clinical outcomes of pulsed radiofrequency neuromodulation for the treatment of occipital neuralgia

Abstract

Objective: Occipital neuralgia is characterized by paroxysmal jabbing pain in the dermatomes of the greater or lesser occipital nerves caused by irritation of these nerves. Although several therapies have been reported, they have only temporary therapeutic effects. We report the results of pulsed radiofrequency treatment of the occipital nerve, which was used to treat occipital neuralgia.

Methods: Patients were diagnosed with occipital neuralgia according to the International Classification of Headache Disorders classification criteria. We performed pulsed radiofrequency neuromodulation when patients presented with clinical findings suggestive occipital neuralgia with positive diagnostic block of the occipital nerves with local anesthetics. Patients were analyzed according to age, duration of symptoms, surgical results, complications and recurrence. Pain was measured every month after the procedure using the visual analog and total pain indexes.

Results: From 2010, ten patients were included in the study. The mean age was 52 years (34-70 years). The mean follow-up period was 7.5 months (6-10 months). Mean Visual Analog Scale and mean total pain index scores declined by 6.1 units and 192.1 units, respectively, during the follow-up period. No complications were reported.

Conclusion: Pulsed radiofrequency neuromodulation of the occipital nerve is an effective treatment for occipital neuralgia. Further controlled prospective studies are necessary to evaluate the exact effects and long-term outcomes of this treatment method.

Keywords: Neuromodulation; Occipital neuralgia; Pulsed radiofrequency.

Fig. 1

Flow diagram of pulsed radiofrequency neuromodulation for occipital neuralgia.

Fig. 2

Anatomic landmarks for the needle insertion point of the greater occipital nerve and lesser occipital nerve. blue circle: external occipital protuberance, GON: greater occipital nerve, LON: lesser occipital nerve, OA: occipital artery.

Fig. 3

Graphs showing pain degree changes over a 6 month period according to various pain measurement: visual analogue scale (A), total pain index (B).