• The Korean Journal of Pain
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• v.12 no.1
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• pp.75-80
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• 1999

Background: Despite tension type headache is popular, the exact mechanism and method of treatment are not certain yet. So, we supposed the basic mechanism of tension type headache is myogenic, and did Tienchu acupoint block, occipital nerve block, and trigger point injection in tension type headache patients. Methods: Fifty-seven tension type headache patients were treated with local anesthetics and small dose of steroid. The intensity of pain and effect of every treatment was evaluated as Verbal Rating Score (VRS; 0~10) before and after every treatment. Evaluation of treatment was based on the time of treatment (1,2 times, 3 times, 4,5 times). Goal of treatment was VRS reaching below two point and it was considered as treated state. Results: Symptom improvement rates of each treatment were 90% (1, 2 times), 91% (3 times), 70% (4, 5 times) respectively. VRS reduction more than 50% rates were 60%, 64%, 60% respectively. Treated state (VRS<2) rates were 33%, 27%, 30% respectively. Conclusion: Tienchu acupoint block, occipital nerve block, trigger point injection were sorts of most effective and simply applicable modalities of treatment in tension type headache.

• Journal of Korean Neurosurgical Society
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• v.58 no.1
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• pp.89-92
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• 2015

Rheumatoid arthritis (RA) is a chronic inflammatory disease involving multiple joints. The cervical spine is often affected, and cases involving atlantoaxial joint can lead to instability. Anterior atlantoaxial subluxation in RA patients can lead to posterior neck pain or occipital headache because of compression of the C2 ganglion or nerve. Here, we report the successful treatment of a RA patient with occipital radiating headache using pulsed radiofrequency therapy at the C2 dorsal root ganglion.

• The Korean Journal of Pain
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• v.14 no.2
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• pp.193-198
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• 2001

Background: Anterior atlantoaxial subluxation (AAS) is a frequent phenomenon in rheumatoid arthritis (RA). AAS compresses the C2 ganglion or nerve and is a cause of posterior neck pain or occipital headache. Methods: We selected RA patients that had developed posterior neck pain or occipital headache caused by AAS. AAS was diagnosed by an increase of ADI (atlantodental interval). A distance of 3 mm or more was considered significant. Patients with vertical subluxation or symptoms suggestive of myelopathy were excluded. Before C2 RF ganglionotomy, we proceeded with a C2 ganglion block or greater occipital nerve block used by local anesthetics. For C2 RF ganglionotomy, the patient was placed in the supine position on a fluoroscopic table. A 100 mm, 4 mm active tip electrode was chosen. Following sensory stimulation at 0.2 to 0.6 V, the lesion was performed at a temperature of $60^{\circ}C$ to $65^{\circ}C$ for 60 sec. We followed up the patient after 6 months later. Results: All cases were female and the average duration of RA was 8.5 years. The duration of posterior neck pain or occipital headache was 1-8 months. The average ADI was 4.2 mm and the McGregor index was 3.3 mm on the average. In all cases, the score on the 4 point Likert scale was 4 (pain free) during the follow-up period. Conclusions: We found that the occipital headache or posterior neck pain caused by AAS in rheumatoid arthritis patients was alleviated over a short term follow up. C2 RF ganglionotomy is suggested as an effective palliative treatment for AAS in RA patients.

• The Korean Journal of Pain
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• v.6 no.1
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• pp.105-108
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• 1993

A myofascial syndrome due to continuous muscle contraction with the trigger point at the upper lateral edge of the nuchal muscles where they attach to the occipital bone is frequently seen in daily pain clinic practice. The Tienchu syndrome is a myofascial condition of the posterior neck region with a trigger point at the Tienchu acupoint(B10). When advanced, occipital neuralgia and muscle contraction headache follow. Therefore, a Tienchu block and/or occipital nerve block with local anesthetic combined with a small dose of steroid is a most effective therapeutic method for many patients who complain of posterior headache or posterior neck pain.

• The Korean Journal of Pain
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• v.21 no.2
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• pp.155-158
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• 2008

This report presents the application of occipital nerve stimulation in two patients with severe and disabling bilateral occipital neuralgia. Pain persisted despite the use of several procedures and the administration of medication in the patients. The patients underwent peripheral nerve stimulation for the treatment of headache. Peripheral nerve stimulation was accomplished via implantation of a subcutaneous electrode to stimulate the peripheral nerve in the occipital area. The patients reported a 90% improvement in overall pain. These cases illustrate the possible utilization of peripheral nerve stimulation for the treatment of occipital neuralgia.

• The Korean Journal of Pain
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• v.23 no.1
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• pp.82-87
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• 2010

Occipital neuralgia is a form of headache that involves the posterior occiput in the greater or lesser occipital nerve distribution. Pain can be severe and persistent with conservative treatment. We present a case of intractable occipital neuralgia that conventional therapeutic modalities failed to ameliorate. We speculate that, in this case, the cause of headache could be the greater occipital nerve entrapment by the obliquus capitis inferior muscle. After steroid and local anesthetic injection into obliquus capitis inferior muscles under fluoroscopic and sonographic guidance, the visual analogue scale was decreased from 9-10/10 to 1-2/10 for 2-3 weeks. The patient eventually got both greater occipital neurectomy and partial resection of obliquus capitis inferior muscles due to the short term effect of the injection. The successful steroid and local anesthetic injection for this occipital neuralgia shows that the refractory headache was caused by entrapment of greater occipital nerves by obliquus capitis inferior muscles.

• The Korean Journal of Pain
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• v.21 no.2
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• pp.150-154
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• 2008

Pulsed or conventional radiofrequency (RF) denervation of the third occipital nerve (TON) is considered to be a safe and effective alternative for the treatment of pain originating from the cervical 2-3 facet joint, including cervicogenic headache. However, proper positioning of the RF probe in the TON can be difficult and time consuming due to the possible involvement of various lesions along the target nerve. We found that bipolar RF is easier to perform and more convenient than unipolar RF when administering a lumbar medial branch block. Here, we report the successful treatment of a patient with a cervicogenic headache by pulsed RF (PRF) denervation of the TON, using a bipolar probe. We believe that bipolar PRF denervation of the TON is an effective alternative to unipolar RF or PRF for the treatment of pain originating from the cervical 2-3 facet joint.

• Clinical Pain
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• v.18 no.1
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• pp.24-30
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• 2019

Objective: Greater occipital nerve block (GONB) is a widely accepted treatment of primary headaches. Two ultrasound (US)-guided blockade techniques exist: 1) the classical distal nerve block technique performed medial to the occipital artery at the superior nuchal line, and 2) the new proximal nerve block technique performed at the obliquus capitis inferior muscle at the level of C2. Our study aim was to perform a head-to-head comparative study of these two US-guided techniques. Method: Forty-nine patients with primary headache treated in our university hospital were recruited. Patients were randomized into two groups of the classical nerve block and the new proximal nerve block techniques. The headache questionnaire was made to assess the intensity of the pain of headache attacks, number of days they experience headache, duration of headache, and amount of pain medication they consumed. Results: In both groups, a decrease in the severity and frequency of the headache was observed. There was no measurable difference in outcome between the two groups. Conclusion: Our study showed that the classic and new proximal techniques are equally effective in decreasing the headache severity and frequency.

• Journal of Sasang Constitutional Medicine
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• v.35 no.1
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• pp.25-34
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• 2023

Objectives The study aimed to investigate the prevalence and characteristics of headaches according to Sasang constitution among 5,764 participants residing in Ansung or Ansan in Korea. Methods The Korea Sasang Constitutional Diagnostic Questionnaire was used to classify the constitution, and a self-administered questionnaire was used to collect headache data. The presence of headache, locations and patterns between groups were analyzed using the chi-square test and logistic regression adjusted for age, marital status, education, alcohol consumption, and smoking. Results Results showed that 25.6% of participants had headaches, with a significantly higher prevalence in Soeumin (30.8%) compared to Soyangin (24.9%) and Taeeumin (24.3%). Soeumin had significantly higher odds ratios for headaches than Taeeumin in both crude (1.387) and adjusted (1.319) models. Headache sites showed high frequency in the order of occipital (8.1%), temporal (8.0%), forehead (5.4%), and global regions (5.4%), and Soeumin showed significantly higher odds ratios of forehead (crude: 1.616, adjusted: 1.543) and occipital pain (crude: 1.366 adjusted: 1.379) compared to Taeeumin. No significant differences in headache patterns were observed among the groups. Conclusions This study suggests that Soeumin has a higher prevalence of headaches, particularly in forehead and occipital regions, compared to other Sasang constitutions.

• Journal of Oriental Neuropsychiatry
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• v.8 no.2
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• pp.85-95
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• 1997

After performing the auricular acupuncture therapy for the functional headache, we came to gain the following therapy effects. 1. In the whole of the patients of the functional headache, housewives of forties were most of all. 2. In the classification of mordern medicine on the patients of the functional headache, muscular contractional headache was most of all and in the classification of oriental differentiation of symtoms and signs(辨證), headache due to deficiency of blood(血虛頭痛) was most of all. 3. In the regional auricular acupuncture therapy for the functonal headache, Taiyang of auricular point(太陽點) had an effect on the lateral headache around the area of Taiyang of auricular point(太陽點) though the actions of sedation, analgesia, Neck of auricular point(頸點) had an effect on the muscular contractional headache of the occipital region, and Stomach of auricular point(胃點) had an effect on the headache of stagnation of phlegm(痰濁頭痛) of anterior region with a chronic digestive disease. 4. The average treatment times of the auricular acupuncture therapy in the patients of the functional headache was 4.08 times, if we have them take auricular acupuncture therapy about 4 times it could be thought to take excellent effect of treatment. 5. The effect of auricular acupuncture therapy for functional headache was turned out to be effective in the following orders ; lateral region(Group A), occipital region(Group B), anterior region(group C). Through the clinical consequences of therapy mentioned above, we came to confirm regular therapeuric effects and hereafter, it is considered that a clinical comparative study on oriental cure and auricular acupuncture therapy for headache has to be more progressed than now.