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Neurological Rehabilitation

Intractable Post-Traumatic Headaches of Mixed Phenotype respond to Cryoneurolysis of Bilateral Greater Occipital Nerves

Friday, October 24, 2025
12:00 PM - 1:30 PM MT
Location: Case Report Theater

    Primary Author(s)

  • Akhil Golla, MD

    Physician
    Albert Einstein Healthcare Network/MossRehab PM&R Program
    Bridgewater, New Jersey

    • Co-Author(s)

  • Stacey Jou, MD

    Brain Injury Medicine Fellow
    Albert Einstein Healthcare Network/MossRehab PM&R Program

  • Miriam Segal, MD

    Program Director
    Albert Einstein Healthcare Network/MossRehab PM&R Program, Pennsylvania

  • Daniel K. Moon, MD

    Attending physician
    Jefferson Moss Magee Rehab
    Elkins Park, Pennsylvania

Disclosure(s):
Akhil Golla, MD: No financial relationships to disclose
Stacey Jou, MD: No financial relationships to disclose
Miriam Segal, MD: No financial relationships to disclose
Daniel K. Moon, MD: No financial relationships to disclose
Case Diagnosis: Cryoneurolysis of Bilateral Greater Occipital Nerve to help mitigate Mixed Phenotypical Post Traumatic Headaches

Case Description or Program Description: 52 year-old male with history of mild traumatic brain injury complicated by post-traumatic headaches of mixed phenotype including migraine-type, tension-type, and occipital neuralgia presented with severe intractable headaches that impaired his ability to participate in activities of daily living (ADLs). Previous treatments included calcitonin gene-related peptide receptor antagonists, peripheral nerve stimulator implant, and monthly greater occipital nerve (GON) blocks. GON blocks notably provided partial relief however the patient was still limited in ADL participation. Therefore, the patient agreed to cryoneurolysis of the bilateral GONs. Ultrasound was used to first localize the GONs. Under aseptic conditions 1 mL of 1% lidocaine was injected at each site for local anesthesia, followed by creation of ice ball at the GONs using a specialized cryoprobe (Iovera).

Setting: Outpatient office

Assessment/Results: Headache pain intensity improved from 8/10 pre-procedure to 0/10 post-procedure. At one and two months follow-up, monthly GON injections were deferred by the patient. He reported longer lasting relief compared to prior interventions, and that his headaches were no longer as debilitating. Outside of clinic, peak headache pain intensity dropped to 3/10, better compared to prior monthly GON blocks. Patient endorsed significantly improved participation in home activities and socialization.

Discussion (relevance): While literature exists on the utilization of cryoneurolysis for specifically occipital neuralgia, there have not been any reports on its effect on post-traumatic headaches of mixed phenotype. Cryoneurolysis in this patient provided significant relief of the occipital neuralgia and the migraine-type and tension-type symptoms of his post-traumatic headaches. Prior monthly GON blocks did not achieve this magnitude and breadth of headache relief. No side effects attributable to the procedure were reported.

Conclusions: Cryoneurolysis can be an effective treatment option that provides relief from post-traumatic headaches of mixed phenotype for up to several months.