Comparison Between Greater Occipital Nerve Block and Pulsed Radiofrequency in the Management of Chronic Migraine

Injection Procedure: 1. Local skin infiltration with 1-2 mL of 1% lidocaine at puncture site. 2. GON block using 3-5 mL of local anesthetic, optionally combined with 20-40 mg triamcinolone ( Bilaterally ) 3. Needle placement confirmed by ultrasound visualization of the nerve and spread of injectate. 4. Observe patient for 15-20 minutes post-injection for immediate adverse events.

1. Introduce RF cannula adjacent to GON under ultrasound guidance. 2. Confirm sensory stimulation: paresthesia at occipital scalp at \<0.5 V. 3. PRF settings: * Temperature: ≤42°C * Pulse duration: 20 ms * Frequency: 2 Hz * Duration: 120 seconds per cycle, 2 cycles per side 4. Continuous monitoring of patient comfort and vital signs.