Background: Third occipital neuralgia (TON) is an uncommon headache caused by C2-3 zygapophyseal joint osteoarthritis. Both continuous and pulsed radiofrequency have been used to treat TON. However, no studies have compared the effects of continuous radiofrequency (CRF) and pulsed radiofrequency (PRF) on TON. This study aimed to determine the most effective treatment for TON.

Methods: A total of 61 patients were enrolled. CRF was performed at 80°C for 90 sec at three target lesions. During PRF, 42°C for 120 sec was applied to the target lesions. Numeric rating scale score (NRS) was assessed in all patients before treatment and at 2 weeks, 3, and 6 months after treatment. Successful treatment was defined as an NRS pain reduction of at least 50% at 6 months, as compared with the pretreatment score.

Results: The mean post treatment pain scores at 2 weeks, 3, and 6 months were significantly lower in both groups. At 2 weeks and 6 months post-procedure, the CRF group showed significantly more pain reduction than the PRF group. The prevalence of pain reduction by at least 50% was lower in the PRF group than in the CRF group. The proportion of patients with > 50% reduction in the NRS was 71% in the CRF versus 50% in the PRF group at the final follow-up.

Conclusion: CRF was associated with earlier and longer pain reduction than PRF in patients with TON. Therefore, CRF should be recommended for patients with TON as much as possible.