Pulsed Radiofrequency of the Occipital Nerves: Results of a Standardized Protocol on Chronic Headache Management

Abstract

Background: Pulsed radiofrequency (PRF) of the occipital nerves has neuromodulative properties and is used for chronic pain management. However, its role in various types of chronic headaches has not been adequately investigated so far. Objectives: Τhis was an observational, open-label, prospective study aiming to assess the efficacy of PRF of occipital nerves on various types of chronic headache management. Methods: Patients with chronic headaches followed up at the pain management unit were scheduled for PRF of both occipital nerves after a positive diagnostic nerve block. PRF was applied following a standardized protocol at 42°C, and the number of headaches per month was assessed as a primary outcome at baseline (before treatment), as well as after 1, 3, and 6 months. Pain intensity during headache crises was recorded using the Numeric Rating Scale (NRS, 0 - 10), Results: Fifty-seven patients suffering from chronic migraines, cluster headaches, tension-type headaches, and occipital neuralgia were studied. PRF significantly improved the number of headache episodes per month, as well as the pain intensity of the crises. The median number of headache episodes per month was significantly reduced in patients with migraine, from 14.5 to 4 after 1 month, and to 6.5 after 6 months. The same was seen for patients with clusters, who were also improved. A statistically significant reduction in NRS values over time was seen for all types of headaches. Conclusions: PRF of the occipital nerves can lead to a reduction of the number of headache episodes per month, improving the intensity of pain during each episode.

Pulsed Radiofrequency for Auriculotemporal Neuralgia: A Case Report

“…The treatments involving local anesthetic blocks of the auriculotemporal nerve and botulinum toxin injections yielded results for our patient that were not entirely satisfactory. Consequently, we decided to apply pulsed radiofrequency as a last resort since this approach successfully treats neuropathic pain conditions, and the short-term and long-term adverse events are very low [ 11 , 15 , 16 , 17 , 18 , 19 ].…”

“…Currently, PRF is used in the treatment of conditions such as radicular pain, occipital and trigeminal neuralgia, as well as shoulder and knee pain. Still, it is also effective in migraine, tension-type headaches, and cluster headaches [ 11 , 15 , 16 , 17 , 18 , 19 ]. Radiofrequency energy used in this technique is not continuous but pulsed, allowing for sufficient cooling to maintain a target temperature below 42 °C and prevent nerve axonotmesis or neurotmesis [ 20 , 21 ].…”

Progress in Clinical Application of Pulsed Radiofrequency for Chronic Pain

“…The results showed that PRF was effective for both occipital neuralgia and migraine [18]. In addition, studies have shown that occipital nerve PRF has a strong positive effect on the management of chronic headache, mainly by reducing the number and intensity of headache attacks per month, and the efficacy still exists after 6 months of treatment [19]. The clinical research on PRF in the treatment of occipital neuralgia at home and abroad is still relatively rare.…”

Pulsed Radiofrequency for Post-Covid Occipital Neuralgia: An Effective Therapeutic Proposal - Case Report

“…Its advantages are the generation of predictable lesions without adhesion or carbonization of tissues, using needles and thin probes with minimal damage to adjacent parts. 8,[10][11][12][13] On the other hand, pulsed radiofrequency (PRF) consists of maintaining the same frequency intensity emitted, but in short pulses, making intervals between emissions to allow the affected tissue to cool. This technique aims to reduce neuronal exposure to higher than ideal temperatures, preserving the sensitivity of the dermatome and maintaining the analgesic character of the procedure.…”