Ultrasound-guided continuous radiofrequency of the C2 dorsal root ganglion for menstrually related migraine: a comparative clinical study

Background Menstrually related migraine (MRM) is a common migraine subtype in women and is often accompanied by gastrointestinal symptoms, anxiety, and depression, leading to substantial functional impairment. Conventional pharmacological treatments show limited efficacy in improving long-term symptoms and quality of life. This study aimed to compare the clinical effectiveness of ultrasound-guided continuous radiofrequency (CRF) of the C2 dorsal root ganglion with conventional zolmitriptan therapy in patients with MRM. Methods This retrospective comparative observational study (using prospectively collected clinical data) included 69 patients with MRM treated between January and December 2024. Patients were assigned to a conventional medication group receiving oral zolmitriptan (Group C, n = 34) or an ultrasound-guided C2 dorsal root ganglion CRF group (Group R, n = 35) based on clinical decision-making. Headache intensity (NRS), attack frequency and duration, nausea and vomiting (VRS), anxiety (HAMA), depression (HAMD), and migraine-related disability (MIDAS) were assessed at baseline and up to 6 months post-treatment. Treatment efficacy and adverse events were assessed at baseline and up to 6 months post-treatment. Results Both groups showed significant improvements in headache symptoms and functional outcomes compared with baseline ( p < 0.001). In the CRF group, significant improvements were observed across all outcome measures from baseline to 6 months, including NRS pain scores (7.5 ± 0.9 to 3.6 ± 0.7), attack frequency and duration, anxiety, depression, and disability scores (all p < 0.001). Between-group comparison showed greater improvements in Group R compared with Group C across multiple time points; however, this comparison should be interpreted with caution given the non-guideline-concordant zolmitriptan regimen. Conclusion In this retrospective comparative observational study, ultrasound-guided continuous radiofrequency of the C2 dorsal root ganglion was associated with greater improvements in headache symptoms, psychological status, and functional disability compared with oral zolmitriptan therapy in patients with MRM, with a favorable safety profile. These findings should be interpreted with caution given the different treatment modalities and study design limitations. Trial registration This study was registered in the Chinese Clinical Trial Registry (ChiCTR2500095771).