1. 2026;29;55-64Ultrasound-guided Pulsed Radiofrequency at the C2 Level for Cervicogenic Headache: Targeting the Greater Occipital Nerve
   Observational Study
   Sukriye Dadali, MD, Seref Celik, MD, Gulcin Babaoglu, MD, Ulku Sabuncu, MD, Ali Costu, MD, Saziye Sahin, MD, and Erkan Yavuz Akcaboy, MD.

BACKGROUND: Cervicogenic headache is a secondary headache disorder caused by cervical spine dysfunction, often associated with neck pain. Among the various treatment options, peripheral nerve blocks targeting the greater occipital nerve are commonly used, with pulsed radiofrequency emerging as a promising therapeutic intervention.

OBJECTIVES: Our study aimed to evaluate the clinical efficacy and safety of ultrasound-guided greater occipital nerve pulsed radiofrequency treatment at the second cervical vertebrae (C2) level in patients with cervicogenic headache. Specifically, we investigated changes in headache duration, intensity, frequency, analgesic use, and patient satisfaction.

STUDY DESIGN: Single-center, prospective, observational cohort study. 

SETTING: Tertiary referral center. 

METHODS: Our study included 43 patients diagnosed with cervicogenic headache according to the International Classification of Headache Disorders Third Edition criteria. A diagnostic greater occipital nerve block was performed on all patients; 34 exhibited a positive response and subsequently received greater occipital nerve pulsed radiofrequency treatment. Data were analyzed by comparing the pretreatment and posttreatment results. 

RESULTS: A total of 32 patients were included in our final analysis. Their mean (SD) age was 55.8 (10.9) years. Significant reductions in headache duration, intensity, and frequency were observed at both the first and third posttreatment months compared to baseline (P < 0.001). Visual Analog Scale scores and analgesic use also showed significant reductions. No statistically significant difference was observed between the first and third posttreatment months regarding these outcomes, and the Global Perceived Effect score remained stable during this period (P = 0.058).

LIMITATIONS: Our study has several limitations that should be considered when interpreting the findings. While the sample size was determined using G*Power (Heinrich-Heine-Universität Düsseldorf), our study population’s relatively small size may affect the generalizability of the results. Furthermore, the inclusion of patients with a history of both cervicogenic headaches and migraines may have introduced diagnostic complexity. Lastly, the relatively short follow-up period may not fully capture the long-term effects of the intervention.

CONCLUSION: Our study demonstrates that, in patients who respond to a diagnostic block, ultrasound-guided greater occipital nerve pulsed radiofrequency treatment at the C2 level effectively reduces the duration, severity, and frequency of cervicogenic headaches, while decreasing analgesic use. These effects appear to persist for at least 3 months, though further research is required to evaluate long-term outcomes. 

KEY WORDS: Cervical pain, headache, pulsed radiofrequency treatment, secondary headache disorders, spinal nerves, Visual Analog Scale, ultrasonography, interventional