Ultrasound-Guided Greater Occipital Nerve Pulsed Radiofrequency for Chronic Headache in Adults Aged 65 Years and Older: A Retrospective Cohort Study.

BACKGROUND AND

OBJECTIVES

Managing chronic headache in older adults is complicated by multimorbidity and polypharmacy. This study evaluated 6-month clinical outcomes, tolerability, and response predictors following ultrasound-guided greater occipital nerve pulsed radiofrequency (GONPRF) in patients aged ≥65 years.

METHODS

This retrospective cohort study analyzed 152 patients undergoing ultrasound-guided GONPRF following a positive diagnostic block (≥50% relief). Pain intensity (numeric rating scale, NRS), headache frequency, attack duration (hours), and analgesic use (days/month) were assessed at baseline and 1, 3, and 6 months. The primary endpoint was therapeutic success, defined as a global perceived effect score ≥6 at 6 months. Predictors of response were analyzed via logistic regression. Adverse events were assessed through clinical records and patient interviews.

RESULTS

Significant improvements occurred in NRS, headache frequency, attack duration, and analgesic use at all follow-up points ( P < 0.001). Therapeutic success was achieved by 56.6%, 52.6%, and 49.3% of patients at 1, 3, and 6 months, respectively. Outcomes were comparable between proximal and distal techniques. Higher baseline analgesic use was the sole independent predictor of a lower likelihood of treatment success ( P = 0.038, OR = 0.95). Adverse events (18.4%) were mild and resolved within 48 hours.

CONCLUSIONS

Ultrasound-guided GONPRF was associated with significant improvements and was well-tolerated in this geriatric cohort. However, due to the retrospective design, lack of a control group, and potential selection bias, the findings should be interpreted cautiously.