The original ultrasound-guided technique for injection of the GON was described by Greher and colleagues in 2010; it targets the nerve as it courses superficial to the obliquus capitis inferior muscle at the C1-C2 level.There are several advanced interventional procedures in clinical use:
Pulsed or thermal radiofrequency ablation (RFA) may be considered for longer-lasting relief after a local anesthetic blockade confirms the diagnosis. Thermal RFA aimed at destroying the nerve architecture can render long-term analgesia but also comes with the potential risks of hypesthesia, dysesthesia, anesthesia dolorosa, and painful neuroma formation. Chemical neurolysis with alcohol or phenol carries the same risks as thermal RFA. There is no such risk with pulsed RF, however, some question its efficacy as compared to other procedures. Neuromodulation of the occipital nerve(s) involves the placement of nerve stimulator leads in a horizontal or oblique orientation at the base of the skull across where the greater occipital nerve emerges. Patients should be trialed with temporary leads first, and greater than 50% pain relief for several days is considered a successful trial after which permanent implantation may be considered. Risks include surgical site infection and lead or generator displacement or fracture after the operation. Ultrasound-guided percutaneous cryoablation of the GON is sometimes performed. At the correct temperature, there should be stunning but not permanent damage of the nerve, but at temperatures below negative 70 degrees Celsius, nerve injury is possible.
Most recently in the literature, a 2018 article by Kastler and colleagues described 7 patients who underwent cryoneurolysis in a non-blinded fashion to good effect, but the follow-up was limited to 3 months. Surgical decompression is often considered to be the last resort. In one study of 11 patients, only two patients did not experience significant pain relief postoperatively and mean pain episodes per month decreased from 17.1 to 4.1, with mean pain intensity scores also decreasing from 7.18 to 1.73. Resection of part of the obliquus capitis inferior muscle has shown success in patients who have an exacerbation of their pain with flexion of the cervical spine. Another popular surgical technique is C2 gangliotomy, even though patients are left with several days of intermittent nausea and dizziness. As with any large nerve resection, there is a theoretical risk of developing a deafferentation syndrome, though arguably the risk is lower if the resection is pre-ganglionic. References
External links

Occipital Neuralgia - National Institute of Neurological Disorders and Stroke