Ultrasound-guided pulsed radiofrequency of the greater occipital nerve in chronic migraine; proximal approach versus distal approach, a single-blind, randomized controlled trial

Background & Objective: Ultrasound-guided pulsed radiofrequency treatment of the greater occipital nerve can be used at distal and proximal levels of the greater occipital nerve in patients with chronic migraine. We aimed to evaluate the treatment efficacy, procedure duration, and pain experienced during the procedure for both methods. Methods: In the study, 60 chronic migraine patients randomly divided into two groups using a computer programme were evaluated. In the proximal group, the greater occipital nerve was accessed at the level of the 2nd cervical vertebra, while in the distal group it was accessed at the level of the protuberencia occipitalis. Patients completed the Migraine Disability Rating Scale, Visual Analogue Scale and a headache diary before treatment as well as at 1 month and 3 months afterwards. The time from the beginning of the intervention to the spread of the stimulus to the C2 dermatome during the sensory stimulation test was recorded. Patients were asked to rate their pain during the procedure using a Visual Analogue Scale. Results: The Visual Analog Scale scores and headache frequencies were significantly decreased in both the proximal group and distal group (p<0.001). The procedure time was shorter (p<0.001) and was less painful in the distal group (p<0.001). Conclusions: In this study, we observed that pulsed radiofrequency of both distal and proximal levels of the greater occipital nerves effectively treated migraine. A shorter procedure time and superior patient tolerability make the distal stimulation the procedure of choice.