Occipital neuralgia

[deleted131481]

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I typically start with GON/LON block by landmarks - local only, no steroids. I've done GON RF with mixed success. If these are unsuccessful will try TON block. I'm thinking of skipping the occipital RF and going to TON next. Curious what others are doing?

As as far as medications, I'll try the usual neuropathics and lidocaine gel.

 

[willabeast]

I typically start with GON/LON block by landmarks - local only, no steroids. I've done GON RF with mixed success. If these are unsuccessful will try TON block. I'm thinking of skipping the occipital RF and going to TON next. Curious what others are doing?

As as far as medications, I'll try the usual neuropathics and lidocaine gel.

I liked to do botox GONB in these situations. They would last anywhere from 3 to 6 months. Since a lot of this pain is stress related, sometimes i would get credit for much longer success 🙂 I did them without xrays, procedure took 5 minutes but would always watch patients for at least 20 minutes since i added some lidocaine.

 

[DOctorJay]

I do ultrasound guided GON blocks with a touch of steroid and some local. I find people do surprisingly well with these.

if they don't work I move to TON blocks and RFA.

 

[deleted131481]

Thanks for the responses.

Anyone familiar with occipital nerve decompression? I've had patients inquire and I tend to strongly discourage any 'nerve decompression' surgery but can't say I have experience. Literature seems to show small case series with good outcomes but I'm skeptical.

 

[painfree23]

I do ultrasound guided GON blocks with a touch of steroid and some local. I find people do surprisingly well with these.

if they don't work I move to TON blocks and RFA.

Do you just block the TON (local only ) x 2 and then RF? Wat do u bill for something like that?

 

[Ducttape]

probably only for the block, unless you got prior auth for the RF.

which many insurances deny.

I do local block with steroid. that doesn't work, I go to MBB then RFA of TON.

 

[DOctorJay]

Do you just block the TON (local only ) x 2 and then RF? Wat do u bill for something like that?

I do it as a C2-4 MBB and then RFA

 

[callmeanesthesia]

Do you just block the TON (local only ) x 2 and then RF? Wat do u bill for something like that?

I just bill it as MBB/RFA of the C2-3 medial branch nerve. Haven’t had any issue with it, with any insurer.