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 patientsexperiencing severe and frequent migraine attacks.

Coccydynia is a chronic pain syndrome with a complex pathophysiology. While ganglion impar blockade (GIB) is an effective treatment, predictors of response are not well-established. This study aimed to evaluate whether hematologic inflammatory indices or coccygeal morphology could predict the clinical response to GIB in patients with chronic coccydynia. We retrospectively reviewed the records of 119 patients who underwent GIB. Demographics, pain characteristics, coccygeal morphology (Postacchini–Massobrio classification), and preprocedural indices were extracted from the medical records. The primary outcome at the 1-month follow-up was a response, defined as either a ≥50% reduction in the visual analog scale pain score or a global perceived effect (GPE) score ≥ 6. Hematologic indices and coccygeal morphology were analyzed to assess their ability to discriminate between responders and nonresponders at 1 month after GIB. The overall response rate was 62.2%, with a significantly higher rate observed in females compared to males ( P = .02). Responders had significantly higher baseline platelet-to-lymphocyte ratio (PLR; P = .006) and systemic immune-inflammation index (SII; P = .023), whereas other indices did not differ. Receiver operating characteristic analysis showed moderate discrimination for PLR (area under the curve = 0.650) and SII (area under the curve = 0.621). While overall coccygeal morphology was not associated with response ( P = .25), types III and V were significantly associated with a higher rate of nonresponse ( P = .048). GIB is an effective treatment for chronic coccydynia. Pre-procedural PLR and SII may serve as accessible biomarkers to identify patients more likely to benefit, while coccygeal types III and V may be associated with poorer outcomes.

Background and Objectives: Predicting treatment response following transforaminal epidural steroid injection (TFESI) in older adults with lumbar radicular pain (LRP) remains challenging. Hematological inflammatory indices have been proposed as accessible biomarkers; however, their clinical utility remains uncertain. This study aimed to evaluate the predictive value of preprocedural hematological inflammatory indices and determine whether clinical variables provide a more clinically relevant framework for predicting TFESI outcomes. Materials and Methods: This retrospective observational study included 190 patients aged ≥65 years who underwent TFESI for LRP. Pain intensity was assessed using the Numeric Rating Scale (NRS) at baseline and after 3 months. Treatment response was defined as a ≥50% reduction in the NRS (meaningful pain response, [MPR-50]). Pre-procedural hematological parameters and derived indices, including the neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), systemic inflammation response index (SIRI), and aggregate index of systemic inflammation (AISI), were calculated. The pain phenotype was categorized as nociceptive, neuropathic, or mixed using the Douleur Neuropathique 4 (DN4) scale. Univariate and multivariable logistic regression analyses were performed, and receiver operating characteristic (ROC) analysis was used to assess the discriminative performance. Results: A meaningful pain response was achieved in 61.1% of the patients. Lymphocyte and monocyte counts were higher in responders; however, effect sizes were small. Importantly, patients with neuropathic pain exhibited significantly higher monocyte counts, SIRI, and AISI, indicating an association between pain phenotype and systemic inflammatory burden; however, these markers were not associated with treatment response. Furthermore, isolated inflammatory indices demonstrated limited standalone discriminative performance in the ROC analysis. In the adjusted hematological model, NLR demonstrated a modest statistical association with MPR-50; however, this association weakened in the final integrated model. Conclusion: Inflammatory indices and pain phenotypes may reflect biological and clinical heterogeneity in older adults with LRP; however, their standalone predictive value for TFESI outcomes appears limited. TFESI responsiveness is likely multifactorial and may be better evaluated using an integrated clinical framework.

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.

Cervicogenic headache is a secondary headache disorder caused by cervical spine dysfunction, often associated with neck pain. Among the various treatment options, peripheral nerve blocks targeting the greater occipital nerve are commonly used, with pulsed radiofrequency emerging as a promising therapeutic intervention. Our study aimed to evaluate the clinical efficacy and safety of ultrasound-guided greater occipital nerve pulsed radiofrequency treatment at the second cervical vertebrae (C2) level in patients with cervicogenic headache. Specifically, we investigated changes in headache duration, intensity, frequency, analgesic use, and patient satisfaction. Single-center, prospective, observational cohort study. Tertiary referral center. Our study included 43 patients diagnosed with cervicogenic headache according to the International Classification of Headache Disorders Third Edition criteria. A diagnostic greater occipital nerve block was performed on all patients; 34 exhibited a positive response and subsequently received greater occipital nerve pulsed radiofrequency treatment. Data were analyzed by comparing the pretreatment and posttreatment results. A total of 32 patients were included in our final analysis. Their mean (SD) age was 55.8 (10.9) years. Significant reductions in headache duration, intensity, and frequency were observed at both the first and third posttreatment months compared to baseline (P < 0.001). Visual Analog Scale scores and analgesic use also showed significant reductions. No statistically significant difference was observed between the first and third posttreatment months regarding these outcomes, and the Global Perceived Effect score remained stable during this period (P = 0.058). Our study has several limitations that should be considered when interpreting the findings. While the sample size was determined using G*Power (Heinrich-Heine-Universität Düsseldorf), our study population's relatively small size may affect the generalizability of the results. Furthermore, the inclusion of patients with a history of both cervicogenic headaches and migraines may have introduced diagnostic complexity. Lastly, the relatively short follow-up period may not fully capture the long-term effects of the intervention. Our study demonstrates that, in patients who respond to a diagnostic block, ultrasound-guided greater occipital nerve pulsed radiofrequency treatment at the C2 level effectively reduces the duration, severity, and frequency of cervicogenic headaches, while decreasing analgesic use. These effects appear to persist for at least 3 months, though further research is required to evaluate long-term outcomes.

Background/Objectives: The optimal duration of pulsed radiofrequency (PRF) applied to the dorsal root ganglion (DRG) remains unclear, particularly in patients with chronic lumbosacral radicular pain (LRP) who are unresponsive to conservative therapy. Although preclinical data suggest duration-dependent neuromodulatory effects, comparative clinical evidence for specific exposure times is limited. This study aimed to evaluate the outcomes of 4 min and 8 min DRG-targeted PRF applications performed in combination with transforaminal epidural steroid injection (TFESI) in patients with chronic LRP unresponsive to conservative treatment, to determine whether prolonged exposure provides superior analgesic and functional outcomes. Methods: In this prospective, single-center, observational comparative study, 72 patients with chronic lumbar radicular pain (LRP) refractory to conservative management received DRG-targeted PRF using standardized parameters (45 V, 20 ms, 2 Hz, ≤42 °C). Participants underwent either 4 min (n = 36) or 8 min (n = 36) PRF, assigned according to clinical discretion. All procedures were followed by transforaminal epidural injection of dexamethasone and bupivacaine. The primary endpoint was Numeric Rating Scale (NRS) pain intensity at 6 months. Secondary endpoints included Oswestry Disability Index (ODI), patient satisfaction, responder rates, and analgesic use across 1-, 3-, and 6-month follow-up. Results: Both groups achieved significant improvements from baseline at all time points. Linear mixed-effects analysis demonstrated a significant overall association favoring the 8 min protocol for pain (estimate: −0.81, 95% CI: −1.52 to −0.10, p = 0.025) and functional disability (estimate: −12.84, 95% CI: −19.36 to −6.32, p < 0.001). Functional benefits emerged by 3 months (p = 0.006), while pain reduction reached borderline statistical significance at 6 months (p = 0.048). The 8 min group showed numerically higher responder rates and patient satisfaction without increased adverse events. Conclusions: In this study evaluating a combined PRF and corticosteroid injection protocol, 8 min PRF exposure was associated with superior pain and functional outcomes compared to 4 min, without compromising safety. However, the observational design and concurrent medication administration limits causal inference. Randomized controlled trials are needed to confirm these findings and isolate the independent effect of PRF duration.