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

<i>Background and Objectives:</i> 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. <i>Materials and Methods:</i> 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. <i>Results</i>: Both groups improved, but LesionRF showed greater benefit. At 12 months, LesionRF achieved a larger MMD reduction (-4.8 days vs. PRF, <i>p</i> < 0.001), higher responder rates (83% vs. 65%, <i>p</i> = 0.01), and greater VAS decreases (-1.6, <i>p</i> < 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, <i>p</i> = 0.037), and two LesionRF patients (1.9%) developed hematomas that resolved conservatively. <i>Conclusions</i>: 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.