OBJECTIVE To analyze the effect and safety of ultrasound-guided continuous stellate ganglion blockade (CSGB) on neurovascular headache. METHODS The clinical data of 137 patients with neurovascular headache treated in the First Affiliated Hospital of Hebei North University from March 2019 to October 2021 were analyzed retrospectively. According to the treatment schemes, the patients were assigned to the control group (69 cases, treated with flunarizine combined with Oryzanol tablets), or the observation group (68 cases, treated with ultrasound-guided CSGB on the basis of the treatment to the control group). The efficacy, headache symptoms, negative emotions, cerebral artery blood flow velocity, vasoactive substance levels and adverse reactions of the two groups were compared. Univariate and logistic multivariate analyses were conducted to explore the risk factors for recurrence of neurovascular headache after treatment. RESULTS The observation group showed a notably higher total effective rate than the control group (95.59% vs. 84.06%, P<0.05). In contrast to the control group, the observation group had notably lower self-rating depression scale (SDS) and Self-Rating Anxiety Scale (SAS) scores and showed notably lower posterior cerebral artery (PCA), middle cerebral artery (MCA), basilar artery (BA) and anterior cerebral artery (ACA) levels (P<0.05). After the treatment, the observation group showed higher levels of serum 5-hydroxy tryptamine (5-HT) and Beta-Endorphin (β-EP) than the control group, but a lower serum neurotensin (NT) level than the control group. Moreover, the incidence of adverse reactions in the two groups was not greatly different (10.29% vs. 5.80%). The observation group showed a lower recurrence rate within 6 months after treatment than the control group (5.88% vs. 18.84%, P<0.05). Univariate and logistic multivariate analyses showed that occupation (physical labor), smoking history and sleep quality (poor) may be the risk factors for recurrence of neurovascular headache after treatment (OR>1, P<0.05), while CSGB may be the protective factor (OR<1, P<0.05). CONCLUSIONS Ultrasound-guided CSGB has obvious analgesic effect on patients with neurovascular headache, which can shorten the duration of headache, improve the cerebral artery blood flow velocity, regulate the levels of vasoactive substances, relieve negative emotions, and lower the recurrence rate, with a high safety.