Improvement of occipital neuralgia by pulsed radiofrequency of the greater occipital nerve combined with local magnesium sulfate injection: a randomized controlled study

ObjectiveTo investigate the safety and efficacy of magnesium sulfate as an adjuvant in pulsed radiofrequency (PRF) stimulation of the greater occipital nerve for the treatment of occipital neuralgia.MethodsConsecutive patients diagnosed with neurogenic occipital neuralgia who attended the Pain Department of Changzhi People’s Hospital were recruited for this study, randomly assigned to control group and experimental group. The control group received PRF treatment on the affected side only, whereas the experimental group received an additional perineural injection of 5% magnesium sulfate (150 mg) around the greater occipital nerve immediately after PRF. NRS scores, pain duration, and pain frequency were compared between the two groups at baseline (T0), 30 days post-treatment (T1), and 60 days post-treatment (T2), at these identical time points, ultrasonography was performed to measure the thicknesses of the ipsilateral semispinalis capitis, obliquus capitis inferior, and deep fascia superficial to the obliquus capitis inferior, along with vertebral artery systolic flow parameters. Additionally, shear wave elastography (SWE) was used to measure the maximum shear wave velocity (SWVmax) and mean shear wave velocity (SWVmean) of the semispinalis capitis to assess cervical musculature status.ResultsA total of 91 patients completed the entire study, with 43 in the control group and 48 in the experimental group. No significant between-group differences were observed preoperatively in occipital neuralgia symptoms (NRS scores, pain duration, and frequency), thickness of the ipsilateral perineural muscles and fascia, shear wave elastography of the semispinalis capitis, or vertebral artery hemodynamic parameters (P>0.05). Pain symptoms were significantly reduced after treatment compared with preoperative levels in both groups(P < 0.05), and patients in the experimental group exhibited significantly alleviated pain symptoms compared with the control group (P < 0.05). No significant differences were detected in muscle, fascia, or vertebral artery parameters in the control group between pre- and post-treatment assessments (P>0.05). In contrast, all parameters of muscle, fascia, and vertebral artery in the experimental group were significantly improved post-treatment compared with baseline (P < 0.05).ConclusionLocal magnesium-sulfate injection enhances pulsed radiofrequency efficacy by relieving perineural muscle spasm and improving vertebral-artery hemodynamics, leading to sustained reductions in headache intensity, duration, and frequency with an excellent safety profile.