This report describes a case of bilateral greater occipital neuralgia treated with cooled radiofrequency ablation. The case is considered in relation to a review of greater occipital neuralgia, continuous thermal and pulsed radiofrequency ablation, and current medical literature on cooled radiofrequency ablation. In this case, a 35-year-old female with a 2.5-year history of chronic suboccipital bilateral headaches, described as constant, burning, and pulsating pain that started at the suboccipital region and radiated into her vertex. She was diagnosed with bilateral greater occipital neuralgia. She underwent cooled radiofrequency ablation of bilateral greater occipital nerves with minimal side effects and 75% pain reduction. Cooled radiofrequency ablation of the greater occipital nerve in challenging cases is an alternative to pulsed and continuous RFA to alleviate pain with less side effects and potential for long-term efficacy. 1. Introduction Greater occipital neuralgia (GON) is a challenging condition in physiatric, neurology, and pain management ambulatory clinics [1, 2]. A wide variety of treatments have been reported but no standard criterion exists [2]. Conservative treatments involve physical therapy, icing, avoiding compression of the nerve, nonsteroidal anti-inflammatory and nerve medications, manual decompression, and local occipital nerve blockade. If these measures fail, patients do have the option to pursue surgical care. Nonsurgical, minimally invasive options include phenol chemodenervation and radiofrequency ablation (RFA) of the affected nerve. Pulsed and continuous RFA for GON [2–4] has been described in current literature for greater occipital nerve ablation; however, cooled radiofrequency ablation has not. In this case report, we briefly review greater occipital neuralgia and compare the differences between pulsed, continuous, and cooled RFA in the treatment of this syndrome. 2. Case Presentation (Methods and Results) A 35-year-old female presented to a physiatric outpatient clinic with a 2.5-year history of chronic suboccipital bilateral headaches that radiated to the posterior scalp and vertex of her head. The pain was described as constant, burning, and pulsating with a severity of 5/10 on the verbal analog scale (Numeric Pain Scale) but has intermittently increased to 10/10 in the previous past 2 weeks. Associated symptoms include insomnia, imbalance, muscle aches, nausea, neck pain, scalp tenderness, tingling, and numbness. The aggravating factors for the pain included flexion, extension, or rotation of neck position, fatigue,
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