Ultrasound Guided Radiofrequency Ablation of the Occipital Nerve

Inclusion Criteria:

* Patients between the ages of 18-80 with a diagnosis of occipital neuralgia or migraine overlying the occipital region.
* A diagnosis of occipital neuralgia will be based on the International Classification of Headache Disorders (ICHD), whose criteria include: paroxysmal stabbing pain in the distribution of the GON, tenderness over the affected nerve, and relief of pain for at least 3 hours after bupivacaine local anesthetic block of the affected nerve.
* Patients may also be included if they have a diagnosis of migraine based on the ICHD criteria with predominance of pain over the occipital region that responded to occipital nerve block.
* Patients must have failed oral medications including NSAIDs, opioids, and anticonvulsants for the management of their pain.
* Failed treatment will be \<50% pain reduction with oral medication.
* Patients must report headache frequency of at least 10 days per month.

Exclusion Criteria:

* Patients will be excluded from the trial if they have an unstable medical or psychological condition,
* are pregnant,
* have an implanted cardiac pacemaker or defibrillator that could not be disabled,
* have had a craniotomy or scar tissue overlying the site from a previous surgery,
* have a history of cervical spine fusion,
* have evidence of elevated ICP or intracranial tumor,
* or have previous RFA treatment of the greater or lesser occipital nerve.