Do bilateral and unilateral greater occipital nerve block effectiveness differ in chronic migraine patients?

Abstract

We aimed to compare the effectiveness of bilateral and unilateral block application in chronic migraine patients and whether there were differences in their effectiveness retrospectively. In chronic migraine patients undergoing Greater occipital nerve (GON) block, mean number of days with pain per month before and after block, mean duration of pain in attacks (in hours), and mean Visual Analog Scale (VAS) in attack and pain severity were recorded from files. The patients underwent one block a week for the first 1 month, thereafter one block a month according to GON block protocol used by our institute. Of 41 patients included in the study, 23 underwent unilateral block (group 1) and 18 underwent bilateral block (group 2). In both groups, number of days with migraine decreased significantly in 2 and 3 months as compared to pre-block treatment (P < 0.001). Mean duration of headache decreased in group 2 during treatment (P < 0.001). In group 1, mean duration of headache also decreased but did not differ significantly (P = 0.051). Mean severity of migraine decreased significantly differ in group 1 in 2, 3 months as compared to pre-block treatment (P < 0.001). No differences were observed in frequency, severity and duration of headache between groups during 3-month treatment period. GON block is effective in chronic migraine and bilateral application is no superior over unilateral application.

Management of refractory chronic migraine using ultrasound-guided pulsed radiofrequency of greater occipital nerve

“…Because local anesthetics and corticosteroids block the transmission in the nociceptive C-fiber and reduce ectopic discharge, [ 25 ] several clinicians applied GON block with anesthetics with or without corticosteroids in patients with migraine, and reported that the GON block successfully reduced the degree of headaches. [ 24 , 26 , 27 ] However, in our cases, GON block was not effective in managing migraine. Therefore, we performed the PRF stimulation to manage our patients’ pain.…”

Anatomical consideration of the occipital cutaneous nerves and artery for the safe treatment of occipital neuralgia

“…Various injection points have been reported such as slightly medial to the SNL rather than palpated along it (Ward, ), 2 cm lateral and 2 cm inferior to the EOP (Inan et al ), the area of greatest tenderness to palpation along the SNL (Tobin and Flitman, ), and 1 ∼ 2 cm below the midpoint of the EOP‐MP line (Afridi et al ). The clinical trend for GON block has been the medial third of the EOP‐MP line (Blumenfeld et al ; Kocer, ; Unal‐Artik et al ), but this was derived from non‐objective evidence of clinical experiences such as success rate and duration of approach rather than objective evidence.…”

“…Conventionally, the anesthetic is injected just medial to the OA‐palpated region or the area of greatest tenderness to palpation along the SNL (Tobin and Flitman, ; Greher et al ). Despite the common use of the GON block, there been no standardized approach to the block technique among clinicians based on exact anatomical information (Ünal‐Artık et al ). Complications of the GON block are uncommon because of its superficial location on the occipital region, but intravascular injection and iatrogenic bleeding from the OA is possible (Ward, ; Unal‐Artik et al ).…”

“…Despite the common use of the GON block, there been no standardized approach to the block technique among clinicians based on exact anatomical information (Ünal‐Artık et al ). Complications of the GON block are uncommon because of its superficial location on the occipital region, but intravascular injection and iatrogenic bleeding from the OA is possible (Ward, ; Unal‐Artik et al ). In addition, the conventional injection technique requires a relatively high volume of anesthetic to ensure a broad nonspecific nerve block.…”

News on the journal Neurological Sciences in 2017

“…Recent clinical experiences have demonstrated the safety, tolerability, and efficacy of non-invasive vagus nerve stimulation for the acute and prophylactic treatment of migraine also in adolescents [79][80][81][82]. Greater occipital nerve block may represent a therapeutic alternative in chronic migraine [83], while transcutaneous supraorbital neurostimulation is a promising technique [84]. Mindfulness or behavioral therapy is emerging as a helpful treatment for pain, also for chronic migraine [85,86], while the role of nutraceuticals in migraine prophylaxis is debated [87].…”