Abstract text (incl. figure legends and references)

Background

Suboccipital headache is one of the main symptoms in various pathologies such as cervicogenic headache, acute and chronic whiplash. Sensitization of the third occipital nerve has been identified as one of the main causes of pain specific to the suboccipital region. Classically transcutaneous stimulation (TENS) has been used to treat the symptoms, however, the inclusion of ultrasound in the physiotherapeutic field allows a more specific invasive treatment, guaranteeing the safety of the intervention.

Objective

To perform a specific, safe and effective percutaneous approach to the third occipital nerve (TON).

Methods

Treatment Parameters with Asymmetrical Biphasic Current:

Materials:

Results

Approximately 1-2 mm superficial to the CII-CIII facet joint in longitudinal view with the probe perpendicular to all planes and about 2-3 cm posterior to the mastoid process and 0.5 cm posterior and inferior to the vertebral artery. A linear probe in longitudinal view is used for this purpose. The out-of-plane or in-plane access will depend on the ergonomics offered by the patient. Doppler mode should be used to locate vascular structures such as the inferior branch of the occipital artery. Sonographically, the TON appears hypoechoic with an internal architecture with a hyperechoic outer rim.

Conclusion

Ultrasound-guided intervention allows a safe physiotherapeutic approach.Percutaneous intervention with electrotherapy allows a physiotherapeutic specific approach.The implementation of electrotherapy is a non-pharmacological alternative, less expensive and more accessible.