{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T10:33:45Z","timestamp":1786617225674,"version":"build-2736575974"},"reference-count":24,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Greater occipital nerve pulsed radiofrequency (GON-PRF) is an effective neuromodulatory treatment for migraine; however, evidence directly comparing unilateral and bilateral approaches remains limited. This prospective randomized controlled trial compared the clinical efficacy of ultrasound-guided proximal GON-PRF performed unilaterally versus bilaterally at the C2 level in patients with migraine. Materials and Methods: A total of 187 patients were randomized to receive unilateral (n = 91) or bilateral (n = 96) ultrasound-guided proximal GON-PRF without concomitant local anesthetic or corticosteroids. Per-protocol analyses included 78 and 88 participants in the unilateral and bilateral groups, respectively. The primary outcome was the change in monthly headache days (MHD) from baseline to 6 months. Secondary outcomes included Visual Analog Scale (VAS) scores, acute medication days (AMD), Headache Impact Test-6 (HIT-6) scores, Migraine Disability Assessment (MIDAS) grades, and Global Perceived Effect (GPE) scores. Longitudinal outcomes were analyzed using multivariable Generalized Estimating Equations (GEE). Results: Of the 187 randomized participants, 166 completed the 6-month follow-up and were included in the per-protocol analysis. Both groups demonstrated significant improvements in all outcomes throughout follow-up (all p &lt; 0.001). At month 6, the Bilateral Group showed lower MHD values (median [IQR]: 7.0 [6.0] vs. 10.0 [6.0], p = 0.030), a higher \u226550% MHD responder rate (77.3% vs. 55.1%, p = 0.003), and lower AMD values (p = 0.024). Adjusted GEE analyses demonstrated significant treatment effects favoring the Bilateral Group for average VAS (p = 0.047) and HIT-6 (p = 0.004). GPE scores also favored the Bilateral Group at month 6 (p = 0.044). No procedure-related complications occurred. Conclusions: Both unilateral and bilateral ultrasound-guided proximal GON-PRF provided significant clinical improvement in patients with migraine. However, bilateral treatment demonstrated superior longitudinal outcomes, including lower headache frequency, reduced acute medication use, higher \u226550% MHD responder rates, and greater patient-reported improvement. These findings remained consistent after adjustment for baseline covariates.<\/jats:p>","DOI":"10.3390\/medicina62081554","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T09:31:09Z","timestamp":1786613469000},"page":"1554","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Longitudinal Outcomes of Bilateral and Unilateral Proximal Greater Occipital Nerve Pulsed Radiofrequency in Migraine: A Prospective Randomized Controlled Trial"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4204-4530","authenticated-orcid":false,"given":"Sukriye","family":"Dadali","sequence":"first","affiliation":[{"name":"Department of Pain Medicine, Ankara Bilkent City Hospital, Ankara 06800, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nevcihan","family":"Sahutoglu Bal","sequence":"additional","affiliation":[{"name":"Department of Pain Medicine, Ankara Bilkent City Hospital, Ankara 06800, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9031-2088","authenticated-orcid":false,"given":"Ulku","family":"Sabuncu","sequence":"additional","affiliation":[{"name":"Department of Pain Medicine, Ankara Bilkent City Hospital, Ankara 06800, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1461-4092","authenticated-orcid":false,"given":"Gulcin","family":"Babaoglu","sequence":"additional","affiliation":[{"name":"Department of Pain Medicine, Ankara Bilkent City Hospital, Ankara 06800, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4383-0146","authenticated-orcid":false,"given":"Ali","family":"Costu","sequence":"additional","affiliation":[{"name":"Department of Pain Medicine, Ankara Bilkent City Hospital, Ankara 06800, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hatice","family":"Babaoglan","sequence":"additional","affiliation":[{"name":"Department of Pain Medicine, Ankara Bilkent City Hospital, Ankara 06800, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1077-3544","authenticated-orcid":false,"given":"Mustafa Cem","family":"Yilmaz","sequence":"additional","affiliation":[{"name":"Department of Pain Medicine, Ankara Bilkent City Hospital, Ankara 06800, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seref","family":"Celik","sequence":"additional","affiliation":[{"name":"Department of Pain Medicine, Ankara Bilkent City Hospital, Ankara 06800, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saziye","family":"Sahin","sequence":"additional","affiliation":[{"name":"Department of Pain Medicine, Ankara Bilkent City Hospital, Ankara 06800, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erkan Yavuz","family":"Akcaboy","sequence":"additional","affiliation":[{"name":"Department of Pain Medicine, Ankara Bilkent City Hospital, Ankara 06800, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1038\/s41582-022-00763-1","article-title":"Global epidemiology of migraine and its implications for public health and health policy","volume":"19","author":"Steiner","year":"2023","journal-title":"Nat. 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