Effectiveness of Third Occipital Nerve Pulsed Radiofrequency in Cervicogenic Headache

Cervicogenic headache is a chronic secondary headache disorder arising from cervical spine structures, particularly the C2-3 zygapophyseal joint and its innervating third occipital nerve. This condition is often resistant to conservative therapies and may significantly impair daily functioning and sleep quality.

Pulsed radiofrequency is a neuromodulatory technique that delivers intermittent high-frequency electrical current while maintaining tissue temperatures below neurodestructive thresholds. This approach is believed to reduce pain by altering nociceptive signal transmission and inflammatory processes without causing permanent nerve injury.

This study is designed as a prospective, single-center, open-label, interventional clinical study conducted at the Algology Clinic of Ankara City Hospital Bilkent. Adult patients aged 18 years and older who are diagnosed with cervicogenic headache according to the International Classification of Headache Disorders (ICHD-3) criteria and who demonstrate a positive response to ultrasound-guided diagnostic third occipital nerve block will be included.

Eligible patients will undergo ultrasound-guided pulsed radiofrequency treatment of the third occipital nerve at the C2-3 zygapophyseal joint level using standard clinical protocols. Pain intensity will be evaluated using the Visual Analog Scale before the procedure and during follow-up visits at predefined time points. Additional outcome measures will include headache frequency, number of headache days, analgesic medication consumption, impact on daily activities and sleep, and patient-reported global perceived effect.

Follow-up assessments will be conducted at 1, 2, and 3 months after the procedure. All adverse events, complications, and safety-related outcomes associated with diagnostic nerve block and pulsed radiofrequency treatment will be recorded throughout the study period.

The primary objective of this study is to evaluate changes in pain intensity following third occipital nerve pulsed radiofrequency treatment. Secondary objectives include assessment of headache-related disability, medication use, patient satisfaction, and safety outcomes. The findings of this study are expected to provide prospective clinical evidence regarding the effectiveness and safety of third occipital nerve pulsed radiofrequency treatment in patients with cervicogenic headache.

Inclusion criteria

• Age 18 years or older
• Diagnosis of cervicogenic headache according to the International Classification of Headache Disorders, 3rd edition (ICHD-3)
• Availability of cranial and cervical spine imaging
• At least 5 headache days per month
• Inadequate response to pharmacological and/or physical therapy treatments
• Ability to understand and provide written informed consent
• Positive response to ultrasound-guided diagnostic third occipital nerve block, defined as at least 50% reduction in pain intensity or patient-reported meaningful improvement

Exclusion criteria

• Secondary headache disorders other than cervicogenic headache according to ICHD-3
• Signs or symptoms of cervical nerve root irritation and/or spinal stenosis
• Sensory deficit in the greater occipital nerve dermatome
• Cranio-cervical structural defects or anatomical abnormalities at or near the target site
• Local or systemic infection
• Non-pharmacological headache treatment within the last 3 months (e.g., physical therapy, botulinum toxin A, acupuncture, ozone therapy, cognitive behavioral therapy)
• Pregnancy or suspected pregnancy
• Known allergy to local anesthetic agents
• History of malignancy
• Known organic disease of the brain or spinal cord
• History of cranial or cervical surgery within the last 12 months
• Bleeding or coagulation disorders or use of oral anticoagulant therapy
• Comorbid conditions that may cause headache (e.g., uncontrolled hypertension, intracranial lesions)
• Conditions that may interfere with treatment adherence or outcome assessment (e.g., psychiatric disorders, dementia)
• Request for re-treatment due to development of contralateral pain or other pain conditions during follow-up
• Refusal to undergo the intervention or withdrawal of consent at any stage of the study