Ultrasound-Guided Greater Occipital Nerve Pulsed Radiofrequency for Chronic Headache in Adults Aged 65 Years and Older: A Retrospective Cohort Study

Background and Objectives: Managing chronic headache in older adults is complicated by multimorbidity and polypharmacy. This study evaluated 6-month clinical outcomes, tolerability, and response predictors following ultrasound-guided greater occipital nerve pulsed radiofrequency (GONPRF) in patients aged ≥65 years. Methods: This retrospective cohort study analyzed 152 patients undergoing ultrasound-guided GONPRF following a positive diagnostic block (≥50% relief). Pain intensity (numeric rating scale, NRS), headache frequency, attack duration (hours), and analgesic use (days/month) were assessed at baseline and 1, 3, and 6 months. The primary endpoint was therapeutic success, defined as a global perceived effect score ≥6 at 6 months. Predictors of response were analyzed via logistic regression. Adverse events were assessed through clinical records and patient interviews. Results: Significant improvements occurred in NRS, headache frequency, attack duration, and analgesic use at all follow-up points ( P < 0.001). Therapeutic success was achieved by 56.6%, 52.6%, and 49.3% of patients at 1, 3, and 6 months, respectively. Outcomes were comparable between proximal and distal techniques. Higher baseline analgesic use was the sole independent predictor of a lower likelihood of treatment success ( P = 0.038, OR = 0.95). Adverse events (18.4%) were mild and resolved within 48 hours. Conclusions: Ultrasound-guided GONPRF was associated with significant improvements and was well-tolerated in this geriatric cohort. However, due to the retrospective design, lack of a control group, and potential selection bias, the findings should be interpreted cautiously.