Long-term efficacy and predictors of response to greater occipital nerve pulsed radiofrequency in migraine with prior preventive treatment failure.

BACKGROUND: Migraine with prior preventive treatment failure represents a significant clinical challenge. While Greater Occipital Nerve (GON) Pulsed Radiofrequency (PRF) is a promising intervention, data regarding its long-term efficacy are limited. This study aimed to evaluate the one-year efficacy of ultrasound-guided GON PRF in this patient population and to identify predictors of a sustained clinical response. METHODS: This retrospective cohort study included 116 adults with migraine and prior preventive treatment failure. The primary endpoint was achievement of the Patient Acceptable Symptom State (PASS) at 12 months, which defined responders. Secondary endpoints included changes in monthly headache days (MHDs), visual analog scale (VAS) scores, patient-perceived improvement assessed using the 7-point Global Perceived Effect (GPE) scale, and treatment durability assessed by Kaplan-Meier analysis. Predictors of response were explored using multivariable logistic regression. RESULTS: At 12 months, 70 of 116 patients (60.3%) achieved the PASS and were classified as responders. Significant reductions were achieved in mean MHDs (from 14.3 to 6.1, p < 0.001) and mean VAS scores (from 6.6 to 5.6, p < 0.05). Kaplan-Meier analysis estimated a 60.3% probability of sustained benefit at one year. Overall, 53.4% of patients reported > 75% improvement on the GPE scale. A strong clinical response at one month was significantly associated with one-year success. Higher baseline mean VAS score was the only independent predictor of long-term success (OR: 1.62). CONCLUSION: GON PRF provides significant and durable clinical benefits for patients with migraine and prior preventive treatment failure. This minimally invasive procedure may represent an effective long-term therapeutic option, and a positive early response may predict sustained clinical success.