Proximal and Distal Approach GON RFT in Migraine

Study Overview
=================
Brief Summary
-----------------
Greater occipital nerve pulsed radiofrequency therapy is used in the treatment of migraine. This method is applied at the level of the proximal c2 vertebra and by approaching the nerve from the distal 1/3 medial of the occipital protuberant. The investigators aimed to compare the effectiveness of these two methods.

Detailed Description
-----------------
Greater occipital nerve (GON) pulsed radiofrequency application is used in migraine headaches. The procedure is applied by approaching the occipital nerve trace with a radiofrequency needle, giving a pulsed radiofrequency current for 4 minutes, and then injecting 2.5 cc bupivacaine and saline. There are two types of applications. In the proximal/central approach, the injection is administered to the occipital nerve between the semispinalis capitis muscle and the obliquus capitis inferior, under ultrasound guidance, while in the distal approach, it is administered 1/3 cm medial to the occipital protuberant with a blind technique. The investigators aim to compare the treatment response at 1 and 3 months between two patient groups treated with both methods. For this purpose, The investigators planned to follow up with 60 patients. GON RF will be performed with a proximal approach to half of the patients and a distal approach to the other half. Pain levels will be measured on the Visual Analogue Scale (VAS) in the 1st and 3rd months after the procedure. Migraine Disability Index (MIDAS) will be applied to the patients in the 1st week and 3rd month after the procedure. Thus, it will be determined whether there is a difference between the approaches in terms of pain palliation. Patients who have undergone the procedure will be found from their file records and called by phone, when they come to the control, face to face and 1-3. In the months, the scales will be filled by calling by phone.

Official Title
-----------------
Proximal and Distal Approach GON RFT in Migraine

Conditions
-----------------
Migraine Disorders, Headache Migraine Chronic

Intervention / Treatment
-----------------
* Procedure: Greater occipital nerve radiofrequency


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Primary migraine hedache, first interventional treatment for headache Exclusion Criteria: Preganancy, malignancy

Ages Eligible for Study
-----------------
Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Proximal block<br>GON block is performed at C2 vertebra level | Procedure: Greater occipital nerve radiofrequency<br>* Greater nerve block and radiofrequency will be performed at the C2 vertebra level or occipital protuberance<br>|
| Other: Distal block<br>GON block is performed at occipital protuberence | Procedure: Greater occipital nerve radiofrequency<br>* Greater nerve block and radiofrequency will be performed at the C2 vertebra level or occipital protuberance<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The MIDAS (Migraine Disability Assessment) questionnaire | The MIDAS (Migraine Disability Assessment) questionnaire was put together to help you measure the impact the headaches. The information on this questionnaire is also helpful the primary care provider to determine the level of pain and disability caused by your headaches. | Change from Baseline MIDAS at 3 months | 
| VAS Visual analog scale | Visual analogue scales (VAS) are psychometric measuring instruments designed to document the characteristics of disease-related symptom severity in individual patients and use this to achieve a rapid (statistically measurable and reproducible) classification of symptom severity and disease control. | Change from Baseline MIDAS at 3 months | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
greater occipital nerve block, radiofrequency