Related Experiment Video
Updated: Apr 1, 2026
Author Spotlight: Minimally Invasive Relief for Occipital Neuralgia at the Nuchal Line
Published on: September 13, 2024
Randomized, double-blind, comparative-effectiveness study comparing pulsed radiofrequency to steroid injections for
Steven P Cohen1, B Lee Peterlin, Larry Fulton
1Departments of Anesthesiology and Critical Care Medicine, and Physical Medicine & Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD, USA, and Uniformed Services University of the Health Sciences, Bethesda, MD, USA Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA Department of Health Organization Management, Texas Tech School of Medicine, Lubbock, TX, USA Departments of Neurology Surgery, and Nursing, Walter Reed National Military Medical Center, Bethesda, MD, USA Department of Anesthesiology, Drexel University, Philadelphia, PA, USA Womack Army Medical Center, Fort Bragg, NC, USA Department of Neurology, Naval Medical Center-San Diego, San Diego, CA, USA Departments of Physical Medicine and Rehabilitation and Anesthesiology, Walter Reed National Military Medical Center, Bethesda, MD, USA Department of Anesthesiology, Boston VA Hospital, Boston, MA, USA Department of Anesthesiology, Naval Medical Center-San Diego, San Diego, CA, USA Department of Surgery, Landstuhl Regional Medical Center, Landstuhl, Germany Department of Surgery, Tripler Army Medical Center, Honolulu, HI, USA Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, USA Departments of Internal Medicine and Neurology, DC VA Hospital, Washington, DC, USA.
Abstract:
Occipital neuralgia (ON) is characterized by lancinating pain and tenderness overlying the occipital nerves. Both steroid injections and pulsed radiofrequency (PRF) are used to treat ON, but few clinical trials have evaluated efficacy, and no study has compared treatments. We performed a multicenter, randomized, double-blind, comparative-effectiveness study in 81 participants with ON or migraine with occipital nerve tenderness whose aim was to determine which treatment is superior. Forty-two participants were randomized to receive local anesthetic and saline, and three 120 second cycles of PRF per targeted nerve, and 39 were randomized to receive local anesthetic mixed with deposteroid and 3 rounds of sham PRF. Patients, treating physicians, and evaluators were blinded to interventions. The PRF group experienced a greater reduction in the primary outcome measure, average occipital pain at 6 weeks (mean change from baseline -2.743 ± 2.487 vs -1.377 ± 1.970; P < 0.001), than the steroid group, which persisted through the 6-month follow-up. Comparable benefits favoring PRF were obtained for worst occipital pain through 3 months (mean change from baseline -1.925 ± 3.204 vs -0.541 ± 2.644; P = 0.043), and average overall headache pain through 6 weeks (mean change from baseline -2.738 ± 2.753 vs -1.120 ± 2.1; P = 0.037). Adverse events were similar between groups, and few significant differences were noted for nonpain outcomes. We conclude that although PRF can provide greater pain relief for ON and migraine with occipital nerve tenderness than steroid injections, the superior analgesia may not be accompanied by comparable improvement on other outcome measures.
