One-day combined botulinum toxin injections and pulsed radiofrequency of greater occipital nerve for treatment refractory chronic migraine

Abstract

Background. The aim of this study was to evaluate the potential of combined the greater occipital nerve’s (GON) pulsed radiofrequency (PRF) with botulinum toxin therapy procedures for treatment the refractory chronic migraine.Methods. We had 6 patients, all female, from 33 to 57 years old suffering from refractory chronic migraine (RCM) according to the European Headache proposed criteria. All patients had migraine from 5 to 44 years and refractory migraine from 1 to 10 years. Simultaneous one-day treatments were undertaken: first step - botulinum toxin type A injections in accordance with the PREEMPT protocol. Second step - the PRF stimulation on the bilateral GONs was performed under the guidance of ultrasound. The follow-up duration after the procedure was 6 months.Results. We had a positive response to treatment from all patients. As a result, we observed a dramatic reduction of pain intensity from 7±1 to 2±2 on NRS scale and, most importantly, a significant decrease in the number of days with headache from 22±5 to 4±4 during first month after treatment, with two patients (30% of patients) recording a complete regression of migraine attacks. None of the patients had any adverse effects.Conclusion. The simultaneous one-day use of PRF GON with botulinum toxin therapy may be a useful option for the treatment of refractory chronic migraine. The combined interventional procedures are effective, minimally invasive, inexpensive, safe, well tolerated and can be performed on an outpatient basis.