The greater occipital nerves and lesser occipital nerves are primarily derived from C2 (variable origins from C1, C3, and C4). An anesthetic blockade is considered to have its clinical eect by reducing pain aerents to the cervical trigeminal nucleus caudalis (1).
The exact mechanism of pulsed radiofrequency ablation is yet to be elucidated. Inan, N et al. conducted a study on 78 migraine patients between 2012 and 2014. The study revealed that repetitive greater occipital nerve blocks with bupivacaine significantly decreased levels of negative symptomatic daily headaches, duration, and visual analog scale (VAS) scores in migraine patients. Patients who did not respond to oral prophylactic agents and patients who had not taken medical prophylaxis had similar responses (2).
Comparable study results are shown by Okmen, K et al. who blocked the greater occipital nerve using 2ml of 0.5% bupivacaine and recognized that it is an eective treatment for migraines (3). A randomized double-blinded comparative study done by Cohen, SP et al. supported the use of occipital nerve pulsed radiofrequency ablation for managing migraine with occipital nerve tenderness (4).