In recent years, occipital nerve block (ONB) has rarely been applied as a treatment for pediatric headache patients.

The greater occipital nerve blocks they offer an alternate option to provide both acute and chronic relief from the suffering of children with difficult to treat headaches. If the short-term effect of peripheral nerve block using local anesthetics is not sufficient, other techniques may be used for long-term pain relief. Several case studies have reported a favorable outcome for pulsed radiofrequency (PRF) neuromodulation . Unlike conventional RF treatment, PRF neuromodulation makes rapid changes in strong electric fields and can lead to alteration of pain signal and pain relief. Moreover, temperatures do not exceed 42℃ during the procedure, and the target nerves and surrounding tissue are not damaged. Thus, the risk of neural damage and neuritis is reduced in the PR.

Thus, the risk of neural damage and neuritis is reduced in the PRF neuromodulation procedure compared with conventional RF treatment.The objective this case is a new possibility of treatment for control of pain.

 

Headache is a common disease in children and adolescents.almost 2 million Brazilian children and adolescents suffer from this disease at least ten days a month. Patient 11 years old, female,already undergoing treatment with several professionals without success during one year, using topiramate, amplictil and amitril, presenting pain as a feeling of tightness, pressure, or heaviness surrounding the head like a headband or helmet. The location is bilateral, with the occipital region predominating, but also the frontal and apical regions. Of mild or moderate intensity, not impeding daily routine activities.The symptoms was pain,(VAS-G) 8 minimum e (VAS-G)10 maximun ,no relief, nocturnal worsening.

 

The study included 1 patient suffering from chronic headache for at least 12 months who were diagnosed with occipital neuralgia. After a favorable response to a diagnostic , PRF neuromodulation was performed. headache pain and quality of life were assessed using a Visual Analogue Scale (VAS) and the Oxford Shoulder Score (OSS) before the diagnostic block and every month after PRF neuromodulation over a 4-month period.

Occipital protuberance and mastoid processes were used as landmarks. We injected a total of 5 mg of dexametasone and 50 mg of 2 % lidocaine in four divided doses under 50 kg of body weight .The division was the right greater occipital nerve and the left occipital nerve, the right lesser occipital nerve and the left occipital nerve for test block .

Soon after performed( one month ) pulsed radiofrequency 42 degrees 480 seconds 2 cycles with the aim of neuromodulation, reduction of inflammatory activity with pulsed and friction reduction.

 The procedure lasted half hour, and the patient was discharged within 24 hours with complete remission of pain.

 

Results:After 24 hours procedures a complete remission of pain and improvement of movement.

 

Conclusion: Our case report demonstrates the benefits of pulsed radiofrequency as part of a multidisciplinary pain management plan to improve function and decrease pain headache. Future studies should assess the

long-term benefits of radiofrequency for pediatric chronic pain.

 

Keywords: occipital neuralgia, pulsed radiofrequency (PRF),headache , children