Effectiveness of distal versus proximal greater occipital nerve pulsed radiofrequency in migraine management: a prospective randomized controlled trial.

Background/aim: We aimed to evaluate the effectiveness of distal versus proximal greater occipital nerve (GON) pulsed radiofrequency (PRF) treatments in patients with episodic or chronic migraine. Materials and methods: In this prospective, randomized controlled study, sixty participants were randomized to either distal GON PRF (n = 30) or proximal GON PRF (n = 30). Migraine related assessments were conducted at the baseline and at the first, second, and third month. Results: Baseline characteristics indicated a higher migraine burden in the proximal group, including increased monthly headache frequency (15.0 vs. 9.5 attacks, p = 0.007). Both groups experienced significant reductions in headache duration, severity and frequency over three months (Friedman test, p < 0.001). Notably, the proximal group experienced greater reductions in severe headache frequency at all time points (1st month: p = 0.004; 3rd month: p = 0.022) and total headache days by the third month (14.0 vs. 9.5 days, p = 0.039). The distal group exhibited some advantages in reducing headache severity (VAS), showing a trend toward improvement in the second month (p = 0.055) and achieving statistical significance by the third month (p = 0.011). No unexpected adverse effects were observed in either group. Conclusion: Both treatments were well-tolerated, with minimal adverse effects. Our findings indicate that both proximal and distal approaches are safe and effective for migraine management. The proximal approach might offer slightly superior outcomes for patients experiencing severe and frequent migraine attacks.