Comparative Long-Term Outcomes of Pulsed and Lesion Radiofrequency of the Greater Occipital Nerve in Chronic Migraine: A 12-Month Cohort Study.

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 with LesionRF (8% vs. 19%; HR 2.15, p = 0.037), and two LesionRF patients (1.9%) developed hematomas that resolved conservatively.

Conclusions

Compared with PRF, LesionRF provided more sustained and clinically meaningful benefits for chronic migraines. Both approaches appeared to be safe, though confirmation in larger randomized trials is warranted.