Third Occipital Nerve Block and Cooled Radiofrequency Ablation for Managing Hemicrania Continua: A Case Report

Hemicrania continua is a rare and debilitating headache disorder characterized by continuous, unilateral pain that responds to indomethacin but is often resistant to other treatments. This report presents the case of a 26-year-old female patient with refractory hemicrania continua and chronic migraine who achieved significant pain relief following a fluoroscopy-guided third occipital nerve block and subsequent radiofrequency ablation (RFA) of the C2-C3 facet joint. The procedure resulted in an immediate reduction of pain as evident from a reduction in the Visual Analog Scale (VAS) score from 10/10 to 0/10, with sustained relief (VAS 2/10) at three months and notable improvement in the patient's quality of life. This case highlights the potential efficacy of targeting the third occipital nerve for the management of hemicrania continua, with thermal RFA (COOLIEF, Avanos Medical, Inc., Alpharetta, GA) offering prolonged relief by ablating nociceptive fibers. Given the emerging evidence supporting the involvement of the third occipital nerve in headache pathophysiology, the third occipital nerve block and RFA represent promising strategies for refractory cases.