STUDY DESIGN: A prospective randomized controlled pilot study. OBJECTIVE: We aimed to assess the effectiveness of pulsed radiofrequency (PRF) stimulation on the atlanto-occipital (AO) joint in patients with chronic joint pain. In addition, we compared the effects of AO intra-articular (IA) PRF and AO IA corticosteroid. SUMMARY OF BACKGROUND DATA: IA injection of corticosteroids into the AO joint is widely used for the management of head and upper cervical pain, and its effectiveness has been shown in previous studies. However, little is known about the effect of PRF stimulation on the AO joint for controlling chronic head or upper cervical pain. METHODS: Twenty-three consecutive patients with chronic upper cervical pain were enrolled according to the inclusion criteria and divided into one of two groups. Twelve patients received PRF stimulation with a PRF needle electrode in the IA space of the AO joint (PRF group) and 11 patients received AO IA corticosteroid injection (ICI group. Pain intensity was assessed using a numeric rating scale (NRS) before treatment and 1, 3, and 6 months afterward. Successful pain relief was defined as ≥50% reduction in NRS score 6 months post-treatment compared to pretreatment. RESULTS: Mean NRS scores were significantly reduced compared to those pretreatment (P < 0.001) in both groups. Temporal changes in NRS score were not significantly different between groups (P = 0.227). Successful pain relief was achieved in 66.7% and 63.6% of patients in the PRF and ICI groups, respectively. CONCLUSION: IA PRF stimulation significantly relieved AO joint pain and its effect persisted for at least 6 months after treatment. In addition, the degree of pain relief after IA PRF was not significantly different from that after ICI. We think that PRF stimulation of the AO joint could be a useful clinical treatment for patients with AO joint pain. LEVEL OF EVIDENCE: 2.