MANAGEMENT OF REFRACTORY CHRONIC MIGRAINE USING ULTRASOUND-GUIDED PULSED RADIOFREQUENCY OF GREATER OCCIPITAL NERVE
Authors: Kwak S and Chang M.C
Study type: Case report
Publication: Case reports, Medicine 2018; 97(45):e13127 (Link to PubMed)
Key Words: Chronic Migraine – Greater Occipital Nerve – Pulsed RF
Graphs created by Boston Scientific based on the published data
To report the response to pulsed radiofrequency (PRF) stimulation of the greater occipital nerve (GON) in two patients with refractory migraine.
Patients: Two patients diagnosed with chronic migraine were recruited for thestudy. Oral medications, GON block with bupivacaine and dexamethasone, andbotulinum toxin injections failed to alleviate the patient’s migraine.
PRF procedure: PRF stimulation of the GON was performed under the guidance of ultrasound as follows:
- Insertion of the catheter needle (22-gauge active curved-tip).
- Sensory stimulation with a PRF generator – RFG4, Cosman Medical™.
- PRF treatment: 5Hz and 5-millisecond pulsed width for 360 seconds at 45V.
- Electrode tip temperature was maintained at or below 42°C.
- Two weeks after applying PRF, the pain was reduced to NRS 3 in both patients, who also reported that the headaches became bearable after PRF.
- The effectiveness of PRF of the GON was sustained for at least 3 months in both patients.
- The number of migraine attacks per month and the duration of the attacks were not significantly changed.
- No adverse effects of the procedure were reported.
- PRF of the GON could be an effective treatment option for the therapeutic management of refractory migraine.
- Further studies involving more patients are still needed to confirm a positive therapeutic response to ultrasound-guided PRF of the GON.