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Evaluate the effectiveness and safety of pulsed radiofrequency in refractory trigeminal neuralgia and chronic cluster headache.

June 1, 2026Open Access

Effectiveness and Risk of Recurrence of Pulsed Radiofrequency in Trigeminal Neuralgia and Chronic Cluster Headache

MDMarta DomínguezHospital Universitario de La Princesa AGAlicia Gonzalez-MartinezHospital Universitario de La Princesa SQS. QuintasHospital Universitario de La Princesa

Key Points

Evaluate the effectiveness and safety of pulsed radiofrequency in refractory trigeminal neuralgia and chronic cluster headache.
Retrospective study of patients diagnosed with TN and CH according to ICHD-3 criteria.
Treatment performed with pulsed radiofrequency targeting Gasserian ganglion for TN and sphenopalatine ganglion for CH.
Effectiveness assessed via pain days reduction, attack frequency, VAS scores, PGI-I, and pain recurrence over an 8-year period.
Clinical improvement in 73.6% of TN patients (14/19) and 83.3% of CH patients (5/6).
A ≥50% response rate achieved in 78.6% of TN patients (11/14) and 66.7% of CH patients (4/6).
Pain recurrence observed in 92.8% of TN patients (13/14) and 100% of CH patients (5/5), primarily within one year.

Abstract

Introduction: Percutaneous pulsed radiofrequency (PPRF) is a minimally invasive neuromodulation technique used in chronic pain management. Our aim was to evaluate its effectiveness and safety in refractory cases of trigeminal neuralgia (TN) and chronic cluster headache (CH). Methods: We conducted a retrospective study of patients with TN and CH diagnosed according to the International Classification of Headache Disorders, 3rd edition (ICHD-3) criteria and treated with PPRF (Gasserian ganglion for TN and sphenopalatine ganglion for CH) over an 8-year period. Effectiveness at 3 months was assessed by evaluating reduction in the number of pain days in TN and number of attacks in CH, ≥50% response rate, visual analogue scale (VAS), Patient Global Impression of Improvement (PGI-I), and pain recurrence. Results: Twenty-five patients met the inclusion criteria, including 19 with TN and 6 with CH, with a mean age of 76 and 52 years, respectively. Clinical improvement was observed in 14/19 (73.6%) patients with TN and 5/6 (83.3%) patients with CH. A ≥50% response rate was achieved in 11/14 (78.6%) patients with TN and 4/6 (66.7%) patients with CH. VAS scores decreased at 3 months in both groups (p < 0.0001 in TN; p = 0.06 in CH). PGI-I was rated as “better” or “much better” in 10/19 (52.6%) patients with TN and 5/6 (83.3%) patients with CH. Pain recurrence occurred in 13/14 (92.8%) patients with TN and 5/5 (100%) patients with CH, mainly after 1 year following the first procedure (7/13 TN and 2/5 CH). No major adverse events were reported. Conclusions: In our series, PPRF appears to be an effective and safe treatment for refractory TN and CH. Although the study is retrospective and the sample size is limited, particularly in CH, these findings should be considered preliminary but clinically relevant. Despite the high recurrence rate, given its low complication profile, it may represent a treatment option for patients who are not candidates for surgical procedures.

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