title: Radiofrequency neurotomy for the treatment of third occipital headache.
abstract: OBJECTIVE
  To evaluate the efficacy of a revised technique of percutaneous radiofrequency neurotomy for third occipital headache.
  
  
  METHODS
  The revisions included using a large gauge electrode, ensuring minimum separation between the three electrode placements, and holding the electrode in place by hand. The revised technique was used to treat 51 nerves in 49 patients diagnosed as suffering from third occipital headache on the basis of controlled diagnostic blocks of the third occipital nerve. The criteria for successful outcome were complete relief of pain for at least 90 days associated with restoration of normal activities of daily living, and no use of drug treatment for the headache.
  
  
  RESULTS
  Of the 49 patients, 43 (88%) achieved a successful outcome. The median duration of relief in these patients was 297 days, with eight patients continuing to have ongoing relief. Fourteen patients underwent a repeat neurotomy to reinstate relief, with 12 (86%) achieving a successful outcome. The median duration of relief in these patients was 217 days, with six patients having ongoing relief. Side effects of the procedure were consistent with coagulation of the third occipital nerve and consisted of slight ataxia, numbness, and temporary dysaesthesia. No side effects required intervention, and they were tolerated by the patients in exchange for the relief of headache.
  
  
  CONCLUSIONS
  Use of the revised procedure greatly improved the rather low success rate previously encountered with third occipital neurotomy. Although the relief of headache is limited in duration, it is profound and can be reinstated by repeat neurotomy. No other form of treatment has been validated for this common form of headache.
authors.affiliation: Department of Clinical Research, University of Newcastle, Royal Newcastle Hospital, Newcastle NSW 2300, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Govind
authors.forename: W
authors.initials: W
authors.lastname: King
authors.forename: B
authors.initials: B
authors.lastname: Bailey
authors.forename: N
authors.initials: N
authors.lastname: Bogduk
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D017115:Catheter Ablation / Q000295:instrumentation / Q000379:methods*; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000294:innervation; D004564:Electrocoagulation / Q000295:instrumentation / Q000379:methods*; D004566:Electrodes; D005260:Female; D006257:Head / Q000294:innervation*; D020773:Headache Disorders / Q000601:surgery*; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000000981:diagnostic imaging / Q000294:innervation; D018710:Pain Clinics; D010523:Peripheral Nervous System Diseases / Q000601:surgery*; D011859:Radiography; D016896:Treatment Outcome