Effectiveness of Third Occipital Nerve Pulsed Radiofrequency in Cervicogenic Headache

Overview

Cervicogenic headache is a secondary headache disorder originating from cervical spine structures and is frequently associated with chronic pain, functional limitation, and impaired quality of life. The third occipital nerve, which innervates the C2-3 zygapophyseal joint, plays an important role in the pathophysiology of cervicogenic headache. Pulsed radiofrequency is a minimally invasive interventional pain management technique that modulates nociceptive transmission without causing permanent neural damage. Although third occipital nerve pulsed radiofrequency is increasingly used in clinical practice, prospective data evaluating its clinical effectiveness and safety remain limited. The aim of this prospective, single-center study is to evaluate the effectiveness and safety of ultrasound-guided third occipital nerve pulsed radiofrequency treatment in patients diagnosed with cervicogenic headache. Pain intensity, headache characteristics, analgesic consumption, and patient-reported outcomes will be assessed before treatment and during follow-up. The results of this study are expected to contribute to clinical evidence supporting interventional treatment strategies for cervicogenic headache.

Cervicogenic headache is a chronic secondary headache disorder arising from cervical spine structures, particularly the C2-3 zygapophyseal joint and its innervating third occipital nerve. This condition is often resistant to conservative therapies and may significantly impair daily functioning and sleep quality. Pulsed radiofrequency is a neuromodulatory technique that delivers intermittent high-frequency electrical current while maintaining tissue temperatures below neurodestructive thresholds. This approach is believed to reduce pain by altering nociceptive signal transmission and inflammatory processes without causing permanent nerve injury. This study is designed as a prospective, single-center, open-label, interventional clinical study conducted at the Algology Clinic of Ankara City Hospital Bilkent. Adult patients aged 18 years and older who are diagnosed with cervicogenic headache according to the International Classification of Headache Disorders (ICHD-3) criteria and who demonstrate a positive response to ultrasound-guided diagnostic third occipital nerve block will be included. Eligible patients will undergo ultrasound-guided pulsed radiofrequency treatment of the third occipital nerve at the C2-3 zygapophyseal joint level using standard clinical protocols. Pain intensity will be evaluated using the Visual Analog Scale before the procedure and during follow-up visits at predefined time points. Additional outcome measures will include headache frequency, number of headache days, analgesic medication consumption, impact on daily activities and sleep, and patient-reported global perceived effect. Follow-up assessments will be conducted at 1, 2, and 3 months after the procedure. All adverse events, complications, and safety-related outcomes associated with diagnostic nerve block and pulsed radiofrequency treatment will be recorded throughout the study period. The primary objective of this study is to evaluate changes in pain intensity following third occipital nerve pulsed radiofrequency treatment. Secondary objectives include assessment of headache-related disability, medication use, patient satisfaction, and safety outcomes. The findings of this study are expected to provide prospective clinical evidence regarding the effectiveness and safety of third occipital nerve pulsed radiofrequency treatment in patients with cervicogenic headache.