Comparison of the Efficacy of Ultrasound-guided Greater Occipital Nerve Block and Pulsed Radiofrequency Therapy in Chronic Migraine Patients: A Randomized Controlled Double-Blind Study
Phase: NA
Conditions: Chronic Migraine, Headache
Sponsor: Eskisehir Osmangazi University

Comparison of the effectiveness of ultrasound-guided greater occipital nerve 
block and pulsed radiofrequency therapy in patients with chronic migraine 
Eskişehir Osmangazi University Department of Pain Management- Eskişehir / Turkey 
Date: 30.04.2019 
Ethical Approval Number: 80558721-050.99-E.34888 
 

 
1 
Study Population 
This prospective study was approved by the Eskisehir Osmangazi University Faculty of 
Medicine institutional review board. Informed written consent was obtained from all 
participants prior to randomization. The participants were informed about procedures and side 
effects. The study protocol conformed to the ethical guidelines of the 1975 Declaration of 
Helsinki as revised in 2000 (the protocol number E.27336). From  April 2019 to April 2020, 
32 patients with chronic migraine were recruited sequentially at the Headache Unit of the 
XXXXX University. The selection of patients to treatment was made by randomization with a 
computer random number generator.  
Inclusion and exclusion criteria were as follows: 
Inclusion Criteria 
• 
Age 18–65; 
• 
ICHD-3 defined chronic migraine 10 
Exclusion Criteria 
• 
Patients who had been started on an effective preventive medication within the past 
three months;  
• 
Medication-overuse headache; 
• 
Treatment with peripheral nerve blocks, trigger point injections or botulinum toxin 
injections within the past three months;  
• 
Known allergic reaction to local anaesthetics;  
• 
Pregnancy or nursing;  
• 
History of another headaches; 
• 
History of chronic medical conditions (e.g. cardiovascular, hepatic, renal, endocrine); 
• 
History of other chronic pain syndromes (e.g. low back pain and fibromyalgia). 

 
2 
The clinical data were collected from the headache diary. All participants were asked to 
record the number of the attack, severity of pain and analgesics consumption in this headache 
diary. A blind researcher made evaluation of these before the start of treatment and 
throughout the study. A visual analogue scale (VAS) from 0 (no pain) to 10 (intense pain) 
was used for the assessment of the pain intensity. 
The study consisted of 2 groups: GON block (group GONB) and GON block + pulsed RF 
(group GONB+PRF). Each group had 16 patients. 
Intervention 
In the operating room, an electrocardiogram, noninvasive blood pressure, and percutaneous 
oxygen saturation were monitored routinely for all patients. Patients were placed in the prone 
position. Ultrasound-guided GONB was performed to locate the nerve more accurately for all 
patients (Figure 1). All procedures were performed using a hockey stick probe. With 0.5 Hz 
sensorial stimulation, a 5-cm-long radiofrequency needle with a 0.5 cm active tip was 
advanced under ultrasound guidance in both pulsed PRF and nerve block groups. USG probe 
was located to medial one-third of the superior nuchal line between the occipital tubercle and 
mastoid process under sterile conditions. Finally, the placement of the needle was verified by 
Doppler imaging of the occipital artery. A 0.3-0.5 Hz sensory stimulus was given with the RF 
device, and the paresthesia sensation in the patient's occipital nerve dermatome was 
questioned, and location verification was performed. Then, GON block was performed in all 
patients by administering 5mg bupivacaine through a PRF needle. After the GON block, the 
PRF neuromodulation was applied at 42 degrees for 4 minutes in the GONB-PRF group. In 
the GONB group, the PRF generator was set for 4 minutes, and the time was waited, but no 
pulse was given. 
 
 

 
3 
Follow up 
The patients were examined for follow-ups at the 1st, 2nd, 3rd, and 6th months after the 
procedure. The severity and the number of migraine attacks, and the number of analgesic 
drugs were noted. The procedure's name performed on the patient was not written in the 
follow-up files. The blindness was broken after the study period was terminated, and the 
procedures were added to patients' files. 
Statistical Analysis 
The SPSS Statistics for Windows, version 22.0 (SPSS Inc., Chicago, Ill., USA) was used as 
the statistical analysis program. Descriptive statistics (mean, standard deviation, frequency, 
and percentage) were used for the demographic and clinical characteristics. Histograms and 
the Shapiro-Wilk tests of normality were used to assess the normal distribution of means. The 
student's t-test was used for comparing two groups of continuous data, which are both 
normally distributed. Comparison of the VAS scores, number of headache attacks and 
analgesics before and after treatment was analyzed by Repeated Measures Analysis of 
Variance (ANOVA). For the Analysis of Variance, Greenhouse-Geisser F statistics were used 
in cases where the sphericity assumption was not met. A p-value of p<0.05 was statistically 
significant.