Management of refractory chronic migraine using ultrasound-guided pulsed radiofrequency of greater occipital nerve: Two case reports

RATIONALE: Although various oral medications and procedures are applied for managing migraine, their efficacy remains limited. To control migraine that does not respond to conventional treatments, we conducted pulsed radiofrequency (PRF) stimulation to the greater occipital nerve (GON) in 2 patients. PATIENT CONCERNS: Patients 1 and 2 complained of chronic throbbing, pulsating, and tight headaches. Their headache intensities scored 8 and 7 on a numeric rating scale (NRS), respectively. Patient 1 experienced the headache bilaterally in the frontal, retro-orbital, parietal, and occipital regions. The initial onset of the symptoms was more than 15 years ago. Patient 2 complained of headaches in the left frontal, retro-orbital, parietal, and occipital regions, which occurred first more than 14 years ago. DIAGNOSES: According to the International Classification of Headache Disorder-3 beta criteria, the patients were diagnosed with chronic migraine. INTERVENTIONS: Oral medications, GON block with bupivacaine and dexamethasone, and botulinum toxin injections did not alleviate the patients’ migraine. The PRF stimulation on GON was performed under the guidance of ultrasound, at 5 Hz and 5-millisecond pulsed width for 360 seconds at 45 V. The electrode tip temperature was maintained at or below 42°C. OUTCOMES: Two weeks after applying PRF, the pain was reduced to NRS 3 in both patients, who also reported that the headache became bearable after PRF. The effectiveness of PRF on GON lasted for at least 3 months in both patients, and no adverse effects were observed. LESSONS: Our findings suggested that the application of PRF on GON can be a useful option for treating refractory chronic migraine.