Using GON block as a diagnostic block: Investigation of clinical efficacy of GON radiofrequency treatment for migraine patients

Abstract

Objective: This retrospective study aimed to investigate the clinical efficacy of GON pulsed radiofrequency (PRF) treatment in migraine patients who did not respond adequately to treatment with greater occipital nerve (GON) blockade. Method: Twenty-seven patients with recurrent episodic migraines or chronic migraines were included in the study. GON blockade was performed bilaterally once a week – four times over a one-month duration. PRF treatment was performed once for those patients who did not show an adequate response to GON blockade, and the treatment was directed at the same sites as the GON blockade. The number of migraine attacks in the preceding 30 days, the total number of triptan tablets taken, the average duration of headache and the highest VAS scores at the first, third and sixth-month visits were recorded. Results: The number of severe migraine attacks, total analgesic use and the maximum duration of migraine episodes were recorded in this study. All these parameters showed a significant decrease from the first month after GON PRF treatment as compared to both the baseline as well as to treatment one month after GON block. In addition, this clinical improvement was sustained up to six months after PRF treatment. Conclusion: Our results suggest that GON PRF treatment is a viable treatment approach in the case of migraine patients who do not respond adequately to treatment with GON blockade.

Pulsed Radiofrequency Neuromodulation of the Greater Occipital Nerve for the Treatment of Headache Disorders in Adults: A Systematic Review

“…Demographic and clinical characteristics of all PRFN treated patients reported in the 22 included studies are summarized in Table 1 . The use of PRFN for the management of a primary headache disorder (migraine disorder, tension type, TAC) was reported in six cohort studies 43–48 and three case reports/series. 49–51 The use of PRFN for the management of a secondary headache disorder (cervicogenic headache or headache caused by atlantoaxial instability) was reported in seven studies: one RCT, 32 four cohort studies 35 , 40–42 and two case reports.…”

“…LMB 4. 120s 5. one (n = 41) or ≥ two (n = 61) Yes (LA + MP) N/A Karaoglan 2022; 43 n = 27 R 1. Mean age (SD): 35.70 ± 4.45 yrs 2.…”

“…Three different interventional targets were found: PRFN was applied at the level of C2 DRG in eight studies, 35 , 40–42 , 46 , 49 , 50 , 52 as a “distal GON approach” in 11 studies, 31–34 , 36 , 37 , 39 , 43 , 44 , 47 , 51 in a “proximal GON approach” in three studies. 38 , 45 , 48 …”

“…Treatment parameters for PRFN consisted of one, 31–38 , 40–43 , 45 , 46 , 48–52 two, 39 , 47 or three 44 cycles on a temperature of 42°C for a duration of 90 40 or 120 39 , 42 , 47 , 49 , 51 to 360 34 , 38 , 43 , 45 , 48 seconds at 40–60 volts. 31 , 34 , 36 , 38 , 39 , 42 , 43 , 48 , 50 Two outliers reported one cycle of 900 seconds. 35 , 50 Pulse widths were indicated as either five 38 , 43 , 45 , 48 or twenty milliseconds.…”

“… 31 , 34 , 36 , 38 , 39 , 42 , 43 , 48 , 50 Two outliers reported one cycle of 900 seconds. 35 , 50 Pulse widths were indicated as either five 38 , 43 , 45 , 48 or twenty milliseconds. 31 , 35 , 36 , 39 , 42 , 44 , 50 , 51 …”