Comparative effectiveness of weekly versus biweekly combined greater and supraorbital nerve blocks in chronic migraine: A retrospective observational cohort study.

BACKGROUND/

OBJECTIVE

Greater occipital nerve (GON) and supraorbital nerve (SON) blocks are effective interventional options for chronic migraine treatment; however, the optimal frequency of injections remains undefined. This study aims to compare the short-term efficacy of weekly and biweekly GON and SON blocks in patients with chronic migraine (CM). The focus will be on pain intensity, monthly headache days (MHD), analgesic consumption and migraine-related disability.

MATERIALS AND

METHODS

This single-center, retrospective cohort study included adults meeting The International Classification of Headache Disorders, 3rd edition (ICHD-3) criteria for chronic migraine who received either weekly (n = 45) or biweekly (n = 52) standardized bilateral GON and SON blocks. The primary outcome was the change in MHD; secondary outcomes were The Visual Analogue Scale (VAS) pain scores, monthly analgesic consumption, The Migraine Disability Assessment (MIDAS) scores, responder rates, and adverse events. Within-group changes were analyzed using the Wilcoxon signed-rank test with Bonferroni correction, and between-group comparisons with the Mann-Whitney U or chi-square test. Effect sizes were calculated using Cohen's d.

RESULTS

Baseline characteristics were comparable between groups (all p > 0.05). Both protocols produced significant improvements in VAS, MHD, analgesic use, and MIDAS scores from baseline to 3 months (all p < 0.001), with large within-group effect sizes (VAS: 2.49 vs. 2.13; MHD: 1.78 vs. 2.16; analgesic use: 1.06 vs. 1.07; MIDAS: 1.18 vs. 1.12 for weekly vs. biweekly, respectively). Between-group differences at follow-up were not statistically significant for any outcome (all p > 0.17), and between-group effect sizes were small (|d| < 0.15). Responder rates at 3 months were similarly high in both groups (e.g.

, MHD: 84.4 % vs. 86.5 %, p = 0.770). Minor adverse events occurred in 6.2 % of patients, with no serious complications.

CONCLUSIONS

Both weekly and biweekly GON + SON block protocols were associated with substantial short-term improvements in pain, headache frequency, medication use, and disability in patients with chronic migraine. A biweekly schedule may offer similar clinical benefits to a weekly regimen and was associated with higher patient adherence, potentially reducing the frequency of procedures and overall healthcare burden.