ultrasound-guided greater occipital nerve blocks and pulsed radiofrequency ablation for diagnosis and treatment of occipital neuralgia

occipital neuralgia is a condition manifested by chronic occipital headaches and is thought to be caused by irritation or trauma to the greater occipital nerve (gon). treatment for occipital neuralgia includes medications, nerve blocks, and pulsed radiofrequency ablation (prfa). landmark-guided gon blocks are the mainstay in both the diagnosis and treatment of occipital neuralgia. ultrasound is being utilized more and more in the chronic pain clinic to guide needle advancement when performing procedures; however, there are no reports of ultrasound used to guide a diagnostic block or prfa of the gon. we report two cases in which ultrasound was used to guide diagnostic greater occipital nerve blocks and greater occipital nerve pulsed radiofrequency ablation for treatment of occipital neuralgia. two patients with occipital headaches are presented. in case 1, ultrasound was used to guide diagnostic blocks of the greater occipital nerves. in case 2, ultrasound was utilized to guide placement of radiofrequency probes for pulsed radiofrequency ablation of the greater occipital nerves. both patients reported immediate, significant pain relief, with continued pain relief for several months. further study is needed to examine any difference in outcomes or morbidity between the traditional landmark method versus ultrasound-guided blocks and pulsed radiofrequency ablation of the greater occipital nerves.