Comparison of the clinical efficacy of bilateral and unilateral GON blockade at the C2 level in chronic migraine

Karaoğlan, Mustafa; Durmuş, İsmail Eren; Küçükçay, Bilge; Takmaz, Suna Akın; İnan, Levent Ertuğrul

doi:10.1007/s10072-021-05739-5

Cited by 7 publications

(13 citation statements)

References 23 publications

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“…Many studies have proven that GON blockade is an effective treatment method for migraine. 25,26,27 The rationale for using a GON block in headache treatment is derived from evidence of the convergence of sensory input to the trigeminal nucleus caudalis neurons from both cervical and trigeminal fibres 28,29 , and its role in antagonising a putative "wind-up-like effect," which may explain the headache improvement. 30 Although there is no standard procedure for GON blockade, the nerve is usually blocked with a mixture of local anaesthetic and corticosteroid using a blind technique.…”

Section: Discussionmentioning

confidence: 99%

Using GON block as a diagnostic block: Investigation of clinical efficacy of GON radiofrequency treatment for migraine patients

Karaoğlan¹,

Küçükçay²

2022

NeuroAsia

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Objective: This retrospective study aimed to investigate the clinical efficacy of GON pulsed radiofrequency (PRF) treatment in migraine patients who did not respond adequately to treatment with greater occipital nerve (GON) blockade. Method: Twenty-seven patients with recurrent episodic migraines or chronic migraines were included in the study. GON blockade was performed bilaterally once a week – four times over a one-month duration. PRF treatment was performed once for those patients who did not show an adequate response to GON blockade, and the treatment was directed at the same sites as the GON blockade. The number of migraine attacks in the preceding 30 days, the total number of triptan tablets taken, the average duration of headache and the highest VAS scores at the first, third and sixth-month visits were recorded. Results: The number of severe migraine attacks, total analgesic use and the maximum duration of migraine episodes were recorded in this study. All these parameters showed a significant decrease from the first month after GON PRF treatment as compared to both the baseline as well as to treatment one month after GON block. In addition, this clinical improvement was sustained up to six months after PRF treatment. Conclusion: Our results suggest that GON PRF treatment is a viable treatment approach in the case of migraine patients who do not respond adequately to treatment with GON blockade.

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Section: Discussionmentioning

confidence: 99%

Using GON block as a diagnostic block: Investigation of clinical efficacy of GON radiofrequency treatment for migraine patients

Karaoğlan¹,

Küçükçay²

2022

NeuroAsia

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“…100 The other four were receiving injections at the C2 level and described unilateral dysmetria, dysdiadochokinesia, and ataxic gait for about 4-6 h after their procedure. 40,101 Skull base abnormalities, such as a previous posterior fossa craniotomy, have been associated with post-injection loss of consciousness 102 and coma, 103 and are considered a contraindication for landmark-based occipital nerve blocks. 23 Finally, one patient was reported to have developed a focal abscess and occipital osteomyelitis in the location of two recently performed GON blocks containing both anesthetic and corticosteroid.…”

Section: Adverse Effects Of Nerve Blocks?mentioning

confidence: 99%

“…Five patients have been reported to develop an acute cerebellar syndrome after GON blocks. 40,100,101 One patient with a Chiari malformation and possible excessive anterolateral neck flexion during positioning was reported to have needle penetration and injection of local anesthetic and non-steroidal anti-inflammatory drugs into the cerebellar tonsils. 100 The other four were receiving injections at the C2 level and described unilateral dysmetria, dysdiadochokinesia, and ataxic gait for about 4-6 h after their procedure.…”

Section: Adverse Effects Of Nerve Blocks?mentioning

confidence: 99%

“…Though serious adverse events are uncommon, a few case reports underscore the importance of proper injection technique. Five patients have been reported to develop an acute cerebellar syndrome after GON blocks 40,100,101 . One patient with a Chiari malformation and possible excessive anterolateral neck flexion during positioning was reported to have needle penetration and injection of local anesthetic and non‐steroidal anti‐inflammatory drugs into the cerebellar tonsils 100 .…”

Section: Lessons Learned From the Literaturementioning

confidence: 99%

“…One patient with a Chiari malformation and possible excessive anterolateral neck flexion during positioning was reported to have needle penetration and injection of local anesthetic and non‐steroidal anti‐inflammatory drugs into the cerebellar tonsils 100 . The other four were receiving injections at the C2 level and described unilateral dysmetria, dysdiadochokinesia, and ataxic gait for about 4–6 h after their procedure 40,101 . Skull base abnormalities, such as a previous posterior fossa craniotomy, have been associated with post‐injection loss of consciousness 102 and coma, 103 and are considered a contraindication for landmark‐based occipital nerve blocks 23 .…”

Section: Lessons Learned From the Literaturementioning

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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Addressing limitations of single GON blockade treatment and repetitive intervention with GON block or onabotulinum toxin A in chronic migraine- part 2 of three men in a boat study

Karaoğlan

2024

Clinical Neurology and Neurosurgery

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Comparison of the clinical efficacy of bilateral and unilateral GON blockade at the C2 level in chronic migraine

Cited by 7 publications

References 23 publications

Using GON block as a diagnostic block: Investigation of clinical efficacy of GON radiofrequency treatment for migraine patients

Using GON block as a diagnostic block: Investigation of clinical efficacy of GON radiofrequency treatment for migraine patients

Narrative review of peripheral nerve blocks for the management of headache

Addressing limitations of single GON blockade treatment and repetitive intervention with GON block or onabotulinum toxin A in chronic migraine- part 2 of three men in a boat study

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