Randomized, double-blind, comparative-effectiveness study comparing pulsed radiofrequency to steroid injections for occipital neuralgia or migraine with occipital nerve tenderness

Abstract

Occipital neuralgia (ON) is characterized by lancinating pain and tenderness overlying the occipital nerves. Both steroid injections and pulsed radiofrequency (PRF) are used to treat ON, but few clinical trials have evaluated efficacy, and no study has compared treatments. We performed a multicenter, randomized, double-blind, comparative-effectiveness study in 81 participants with ON or migraine with occipital nerve tenderness whose aim was to determine which treatment is superior. Forty-two participants were randomized to receive local anesthetic and saline, and three 120 second cycles of PRF per targeted nerve, and 39 were randomized to receive local anesthetic mixed with deposteroid and 3 rounds of sham PRF. Patients, treating physicians, and evaluators were blinded to interventions. The PRF group experienced a greater reduction in the primary outcome measure, average occipital pain at 6 weeks (mean change from baseline −2.743 ± 2.487 vs −1.377 ± 1.970; P <0.001), than the steroid group, which persisted through the 6-month follow-up. Comparable benefits favoring PRF were obtained for worst occipital pain through 3 months (mean change from baseline−1.925 ± 3.204 vs−0.541 ± 2.644; P = 0.043), and average overall headache pain through 6 weeks (mean change from baseline −2.738 ± 2.753 vs −1.120 ± 2.1; P = 0.037). Adverse events were similar between groups, and few significant differences were noted for nonpain outcomes. We conclude that although PRF can provide greater pain relief for ON and migraine with occipital nerve tenderness than steroid injections, the superior analgesia may not be accompanied by comparable improvement on other outcome measures.

New Technique for Cryoneuroablation of the Proximal Greater Occipital Nerve

“…There are a variety of minimally invasive treatments used for occipital neuralgia, including steroid injections, pulse radiofrequency (PRF), cryoneuroablation (CNA), radiofrequency ablation (RFA), occipital stimulation, and C2 gangliotomy, all of which have been performed with some success . Steroid injections, RFA, PRF, and CNA are often done at the nuchal ridge, just medial to the occipital artery.…”

Treatment of Occipital Neuralgia by Thermal Radiofrequency Ablation

“…Although many interventional and surgical procedures have been described in the literature, few studies have evaluated the efficacy or duration of action of these treatment options. [7][8][9] Specifically, published data regarding the utility and efficacy of thermal radiofrequency ablation (TRF) for the treatment of occipital neuralgia are limited. 10 Given the paucity of published data regarding the utility of TRF for the treatment of occipital neuralgia, this study aimed to delineate the effectiveness of this treatment modality.…”

Practical considerations of linear accelerator‐based frameless extracranial radiosurgery for treatment of occipital neuralgia for nonsurgical candidates

“…Numerous treatment options may be warranted for patients with continued disabling and intractable pain despite temporary treatments or when invasive therapies such as surgical incision, radiofrequency ablation, injected neurotoxin facilitated nerve blocking, implanted nerve stimulator, or surgically decompressing the nerve fail to provide relief . If the condition continues to be refractory, nerve sparing procedures are utilized in preference to neurodestructive surgeries . Neurodestructive procedures, such as neurectomies, are highly invasive and carry some degree of risk of permanent complication .…”