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Abstract
Background and Aims Occipital Neuralgia (ON) is defined as unilateral or bilateral paroxysmal, shooting or stabbing pain in the posterior part of the scalp, representing approximately 4% of all cranial neuralgias. This report aims to present the effects of Radiofrequency ablation (RFA) of occipital nerves in two patients with chronic ON.
Methods We present the case of two female patients (48 and 53 years old), admitted to our Pain Clinic, complaining about ON, refractory to medical treatment (NSAIDs, Paracetamol, Triptans) for over 30 years. They referred over 15 episodes per month of sharp pain located occipitally, radiating frontally and at the cervix and characterized by paresthesias occipitally. After diagnostic blocks of greater(GON) and lesser(LON) occipital nerves we decided the application of RFA of these nerves. Peri-procedurally, the patients remained in the sitting position, with the cervix slightly flexed. After local infiltration, a 500mm, 22G, RF-Cannula (DIROS) with a 5mm active tip was placed at the point one-third medially of the way between the occipital protuberance and the mastoid process (for GON) and another one at the point two-thirds of the way between the inion and the mastoid process (for LON) bilaterally. After conduct sensory testing, Pulsed RF-thermocoagulation was initiated at 42°C for 10 minutes.
Results Seven days post-proceduraly both patients presented completely relieved of headaches, stating complete return to everyday life. One month post-procedurally they referred annihilation of ON attacks and discontinuation of complementary medical treatment.
Conclusions RFA of occipital nerves, a minimal invasive procedure, seems to be an effective treatment option for persistent ON.