Comparative Long-Term Outcomes of Pulsed and Lesion Radiofrequency of the Greater Occipital Nerve in Chronic Migraine: A 12-Month Cohort Study
Abstract
Background and Objectives: Chronic migraines are a disabling neurological disorder with limited response to preventive pharmacological treatments. Greater occipital nerve (GON)-targeted radiofrequency (RF) procedures have emerged as promising interventions, yet long-term comparative data between pulsed RF (PRF) and continuous-lesion RF (LesionRF) remain scarce. This study evaluated the 12-month efficacy and safety of PRF versus LesionRF. Materials and Methods: A single-center cohort of 211 patients with chronic migraine diagnosed by ICHD-3 criteria (PRF = 107; LesionRF = 104) was analyzed. All patients had a positive diagnostic block and ≥12 months of follow-up. Interventions were performed under ultrasound guidance with standardized protocols (PRF: 42 °C, 4 min, 45 V; LesionRF: 80 °C, 90 s). The primary outcome was a change in monthly migraine days (MMD), while secondary outcomes included responder rates (≥50% MMD reduction), pain intensity (VAS), functional outcomes (HIT-6, MIDAS), quality of life (SF-36, EQ-5D), medication use, retreatment, and complications. Results: Both groups improved, but LesionRF showed greater benefit. At 12 months, LesionRF achieved a larger MMD reduction (−4.8 days vs. PRF, p < 0.001), higher responder rates (83% vs. 65%, p = 0.01), and greater VAS decreases (−1.6, p < 0.001). Functional and quality-of-life scores improved more with LesionRF, with MIDAS reductions surpassing MCID and responder rates meeting PASS. Retreatment was less frequent…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 211 participants or records.
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