Comparison of the Efficacy of Ultrasound-Guided Repeated Greater Occipital Nerve Blocks and Greater Occipital Nerve Pulsed Radiofrequency in Migraine Treatment.

Background: Greater occipital nerve (GON) blocks and pulsed radiofrequency (PRF) are commonly used in migraine management.

Objectives: This study compares the clinical outcomes of migraine patients who underwent repeated GON blocks (GONBs) and pulsed radiofrequency of the greater occipital nerve (GONPRF), both of which were performed using a proximal technique with ultrasound (US)-guidance.

Study design: Single-center, prospective, comparative, observational cohort study.

Setting: Tertiary referral center.

Methods: Patients who were diagnosed with migraines based on the criteria from the International Classification of Headache Disorders III, experienced migraine attacks at least once a week or 5 times per month, did not respond to preventive migraine medications, and had a positive response to diagnostic GONB treatment (2-4 mL of 0.25% bupivacaine) were included in the study.The first group (the GONBs group) consisted of patients who could visit the clinic regularly. In this group, a GONB was administered at the C2 level using a proximal technique under US-guidance once a week for 4 weeks. The second group (the GONPRF group) included patients who, for various reasons, had only a limited ability to attend weekly treatments. In this group, GONPRF was performed at the C2 level using a proximal technique under US-guidance.For both groups, the following outcomes were evaluated at the first, second, and third months after treatment: headache attack duration, monthly frequency of headache attacks, number of headache days, and average monthly headache visual analog scale (VAS) scores. All side effects and adverse events related to the treatments were recorded, as were those effects' and events' duration.

Results: A total of 68 patients were included in the study, with 35 in the GONPRF group and 33 in the GONBs group. No significant differences were observed between the 2 groups in terms of baseline demographic and clinical characteristics. Over the study period, the duration of headache attacks showed much greater improvement in the GONPRF group than in the GONBs group. In the first month, headache duration decreased in both groups, but the difference between them was not significant. However, in the second month, the GONPRF group exhibited a significantly shorter median headache duration. As for attack frequency, no significant differences were noted at baseline. By the first month, the GONPRF group showed a significantly lower median attack frequency than did the GONBs group. This trend continued into the second and third months. The mean number of headache days also showed more significant reductions in the GONPRF group than in the GONBs group, and this difference remained significant at both the second and third months. VAS pain scores were comparable at baseline. By the second month, the GONPRF group had significantly lower pain scores, and this difference persisted into the third month. Side effects were mild and transient, with no persistent or serious adverse events observed in either group.

Limitations: A small sample size, a relatively short 3-month follow-up period, and a single-center location are the main limitations of this study.

Conclusion: This study demonstrates that, when compared to GONBs, ultrasound-guided proximal GONPRF yields significantly greater reduction headache duration, frequency, and severity for migraine patients, providing at least 3 months of relief.