Injection Procedure:

1. Local skin infiltration with 1-2 mL of 1% lidocaine at puncture site.
2. GON block using 3-5 mL of local anesthetic, optionally combined with 20-40 mg triamcinolone ( Bilaterally )
3. Needle placement confirmed by ultrasound visualization of the nerve and spread of injectate.
4. Observe patient for 15-20 minutes post-injection for immediate adverse events.

1. Introduce RF cannula adjacent to GON under ultrasound guidance.

2. Confirm sensory stimulation: paresthesia at occipital scalp at <0.5 V.

3. PRF settings:

   • Temperature: ≤42°C
   • Pulse duration: 20 ms
   • Frequency: 2 Hz
   • Duration: 120 seconds per cycle, 2 cycles per side

4. Continuous monitoring of patient comfort and vital signs.

Injection Procedure:

1. Local skin infiltration with 1-2 mL of 1% lidocaine at puncture site.
2. GON block using 3-5 mL of local anesthetic, optionally combined with 20-40 mg triamcinolone ( Bilaterally )
3. Needle placement confirmed by ultrasound visualization of the nerve and spread of injectate.
4. Observe patient for 15-20 minutes post-injection for immediate adverse events.

after do GONB and Pulsed radio frequency we assess improvement of Episodic Pain over period of Follow up