Ultrasound Guided Radiofrequency Ablation of the Occipital Nerve

Inclusion criteria

• Patients between the ages of 18-80 with a diagnosis of occipital neuralgia or migraine overlying the occipital region.
• A diagnosis of occipital neuralgia will be based on the International Classification of Headache Disorders (ICHD), whose criteria include: paroxysmal stabbing pain in the distribution of the GON, tenderness over the affected nerve, and relief of pain for at least 3 hours after bupivacaine local anesthetic block of the affected nerve.
• Patients may also be included if they have a diagnosis of migraine based on the ICHD criteria with predominance of pain over the occipital region that responded to occipital nerve block.
• Patients must have failed oral medications including NSAIDs, opioids, and anticonvulsants for the management of their pain.
• Failed treatment will be <50% pain reduction with oral medication.
• Patients must report headache frequency of at least 10 days per month.

Exclusion criteria

• Patients will be excluded from the trial if they have an unstable medical or psychological condition,
• are pregnant,
• have an implanted cardiac pacemaker or defibrillator that could not be disabled,
• have had a craniotomy or scar tissue overlying the site from a previous surgery,
• have a history of cervical spine fusion,
• have evidence of elevated ICP or intracranial tumor,
• or have previous RFA treatment of the greater or lesser occipital nerve.