Comparison of greater occipital nerve and supra orbital nerve blocks methods in the treatment of acute migraine attack: A randomized double-blind controlled trial

Hökenek, Nihat Müjdat; Özer, Duygu; Yı́lmaz, Erdal; Başkaya, Nurhayat; Hokenek, Ummahan Dalkilinc; Ak, Rohat; Güven, Ramazan; Erdoğan, Mehmet Özgür; Mepham, Lewis Aaron

doi:10.1016/j.clineuro.2021.106821

Cited by 6 publications

(10 citation statements)

References 28 publications

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“…There are now 12 RCTs that examine the evidence for GON blocks in migraine, discussed in greater detail in Table 1. Of the trials that compared GON blocks to a placebo for the treatment of migraine, all but one of these 3 showed at least some benefit of GON blocks, most often in headache severity 4,29,30,36,38,39,45–47 . In the trial with no significant benefit, there is speculation that the placebo group (0.25 ml 1% lidocaine) may have produced a therapeutic effect, making the difference between groups difficult to detect 25 …”

Section: Indications For Nerve Blocksmentioning

confidence: 99%

“…Of the trials that compared GON blocks to a placebo for the treatment of migraine, all but one of these 3 showed at least some benefit of GON blocks, most often in headache severity. 4,29,30,36,38,39,[45][46][47] In the trial with no significant benefit, there is speculation that the placebo group (0.25 ml 1% lidocaine) may have produced a therapeutic effect, making the difference between groups difficult to detect. 25 In patients who receive a GON block during a migraine attack, migraine-related pain, allodynia, and photophobia may be reduced within 5 min, 48 with randomized studies showing improved headache severity at 20 min, 37 30 min, 47 and 120 min 38 after GON blocks.…”

Section: Indic Ations For Nerve Block S Migrainementioning

confidence: 99%

“…4,29,30,36,38,39,[45][46][47] In the trial with no significant benefit, there is speculation that the placebo group (0.25 ml 1% lidocaine) may have produced a therapeutic effect, making the difference between groups difficult to detect. 25 In patients who receive a GON block during a migraine attack, migraine-related pain, allodynia, and photophobia may be reduced within 5 min, 48 with randomized studies showing improved headache severity at 20 min, 37 30 min, 47 and 120 min 38 after GON blocks. The reported duration of effect varies between studies and among individual patients, but many studies report some level of response for days to weeks.…”

Section: Indic Ations For Nerve Block S Migrainementioning

confidence: 99%

“…The target area for the GON block is approximately one third of the distance between these two points, starting from the occipital protuberance (see Figure 1B). 1,3,36,37 Another method uses distance from the occipital protuberance, typically 1.5–2 cm lateral and 2–3 cm inferior 4,30,38–40 . Clinicians can also palpate for the occipital artery pulse about 2 cm lateral to the occipital protuberance.…”

Section: Nerve Block Anatomy and Techniquementioning

confidence: 99%

“…1,3,36,37 Another method uses distance from the occipital protuberance, typically 1.5-2 cm lateral and 2-3 cm inferior. 4,30,[38][39][40] Clinicians can also palpate for the occipital artery pulse about 2 cm lateral to the occipital protuberance. The occipital nerve is often, but not always, just medial to the artery.…”

Section: Greater Occipital Nerve Blockmentioning

confidence: 99%

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Narrative review of peripheral nerve blocks for the management of headache

et al. 2022

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Objective: To provide an overview of the current available literature on peripheral nerve blocks for the management of migraine and other headache disorders in adults.Background: Peripheral nerve blocks have been commonly performed in the headache practice for migraine, cluster headache, occipital neuralgia, and other headache disorders, despite a paucity of evidence supporting their use historically. In the past decade, there has been an effort to explore the efficacy and safety of peripheral nerve blocks for the management of headache, with the greatest interest centered around greater occipital blocks. Design:We performed a search in PubMed using key words including "occipital nerve blocks," "peripheral nerve blocks," "occipital nerve," "migraine," "cluster headache," and "neuralgia." We reviewed the randomized controlled trials (RCTs), observational studies, and case series, and summarized the anatomy, techniques, and the evidence for the use of peripheral nerve blocks in different headache disorders, with particular focus on available RCTs. Case reports were included for a detail review of adverse events.Results: Of 12 RCTs examining the use of greater occipital nerve blocks for migraine, all but one demonstrate efficacy with reduction in headache frequency, intensity, and/or duration compared to placebo. Studies have not demonstrated a difference in clinical outcomes with the use of corticosteroids for nerve blocks compared to blocks with local anesthetic in the treatment of migraine. There are two RCTs supporting the use of greater occipital blockade for cluster headache, both showing benefit of suboccipitally injected corticosteroid. One RCT suggests benefit of greater occipital nerve blocks for cervicogenic headache. Observational studies and case series/reports show that greater occipital nerve block may be effective in prolonged migraine aura, status migrainosus, post-dural puncture headache, and occipital neuralgia. Overall, peripheral nerve blocks are well tolerated. Serious side effects are rare but have been reported, including acute cerebellar syndrome and infection.Conclusions: Peripheral nerve blocks, especially occipital nerve blocks, are a viable treatment option for migraine and may be helpful in cluster headache as a transitional therapy or rescue therapy.

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Section: Indications For Nerve Blocksmentioning

confidence: 99%