Presented at the 2012 AAPM Annual Meeting « Back

Pulsed Radio Frequency Energy in the Treatment of Occipital Neuralgia with Chronic, Debilitating Headache: A Report of Four Cases

Robert S. Stall, MD, robertstall176@hotmail.com, Veterans Administration, Ridgeland, Mississippi

Introduction: Occipital neuralgia is an often overlooked cause of chronic headaches. This case series reports the effect of a novel treatment for occipital neuralgia utilizing transcutaneous pulsed radiofrequency energy (PRFE)—a noninvasive, nonpharmacologic approach. A review of the medical literature suggests that this is the first reported use of this modality for this disorder. All previous reported uses of PRFE to treat occipital neuralgia have been percutaneous. Material/Methods: Four patients with chronic occipital neuralgia, who had been treated successfully for 1 to 4 years with blocks of the bilateral greater and lesser occipital nerves (GLONB) were identified. Baseline headache frequency, duration, lost productivity due to headache, medication utilization, and associated symptoms, such as photophobia, phonophobia, etc., were well established over a period of years. The Provant PRFE system emits nonionizing, nonthermal radiofrequency energy through an applicator pad placed directly over the occiput for 30 minutes twice a day. All four patients agreed to try Provant as a substitute for their GLONB for a period of 30 days. Results: Three out of four patients reported decreased frequency and severity of headache pain compared to baseline. Two patients reported a reduction in lost productivity. One patient reported a significant (nearly 100%) reduction in utilization of prn narcotics during the treatment period. Two patients reported reduction or elimination of one or more associated symptoms associated with prostrating headaches. Conclusions: The Provant system for delivering PRFE at home is a novel and effective treatment for occipital neuralgia. References: 1)Mosser, Scott W. MD; Guyuron, Bahman MD; Janis, Jeffrey E. MD; et al.; The Anatomy of the Greater Occipital Nerve: Implications for the Etiology of Migraine Headaches, Plastic and Reconstructive Surgery: Feb 2004 – Vol. 113, Issue 2, pp 693-697 2)Naja, Zoher M., MD; El-Rajab, Mariam, MD; Al-Tannir, Mohamad A., MPH; et al.; Repetitive Occipital Nerve Blockade for Cervicogenic Headache: Expanded Case Report of 47 Adults; Pain Practice: Dec 2006 - Vol. 6, Issue 4, pp 278-284 3)Dash, Krishna S., MD; Janis, Jeffrey E. MD; Guyuron, Bahman, MD; The Lesser and Third Occipital Nerves and Migraine Headaches; Plastic and Reconstructive Surgery: May 2005 – Vol. 115, Issue 6, pp 1752-1758 4)Ward, John B.; Greater Occipital Nerve Block; Seminars in Neurology: 2003 – Vol. 23, Issue 1, pp 59-62 5)Ehni, George; Benner, Benjamin; Occipital Neuralgia and the C1-2 Arthrosis Syndrome; Journal of Neurosurgery: Nov 1984 – Vol. 61, No. 5, pp 961-965 6)Hecht, Jeffrey S.; Occipital Nerve Blocks in Post Concussive Headaches: A Retrospective Review and Report of Ten Patients; Journal of Head Trauma Rehabilitation: Jan/Feb 2004 – Vol. 19, Issue 1, pp 58-71

Funding: None