title: Noninvasive pulsed radio frequency energy in the treatment of occipital neuralgia with chronic, debilitating headache: a report of four cases.
abstract: OBJECTIVE
  To examine the effects of noninvasive pulsed radio frequency energy (PRFE) on recurrent migraine headache associated with occipital neuralgia.
  
  
  METHODS
  Four patients who were receiving long-term treatment with repeated greater and lesser occipital nerve blocks (GLONBs) to control recurrent migraine resistant to other treatment underwent treatment with noninvasive PRFE at home as a substitute for GLONB treatment. PRFE was administered by the patient at home for 30 minutes twice daily through an applicator pad placed directly over the occiput and upper cervical spine.
  
  
  RESULTS
  Three of four patients reported a decrease in frequency, severity, or both of nonprostrating and prostrating migraines compared with their baseline symptoms; one reported no change from baseline. Comparing PRFE results with those obtained after nerve blocks, three of four patients reported decreases in nonprostrating migraines, while two reported a decrease in prostrating migraines. One patient reported an increase in prostrating migraine frequency. Variable degrees of increased productivity, decreased opioid and nonopioid analgesic use, and decreased visits to urgent care clinics were noted. In two patients who had combined PRFE and GLONB, marked improvement was noted in all symptoms.
  
  
  CONCLUSIONS
  Improvement in frequency of headaches was noted, especially when PRFE was combined with GLONB. Further study is warranted.
authors.affiliation: Montgomery VA Medical Center, Jackson, Mississippi, USA. robert.stall@va.gov
authors.forename: Robert S
authors.initials: RS
authors.lastname: Stall
mesh_terms: D000328:Adult; D005260:Female; D020773:Headache Disorders / Q000150:complications* / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D009437:Neuralgia / Q000150:complications* / Q000175:diagnosis / Q000628:therapy*; D061208:Pulsed Radiofrequency Treatment / Q000379:methods*; D004561:Transcutaneous Electric Nerve Stimulation / Q000379:methods*; D016896:Treatment Outcome