Effectiveness of Greater Occipital Nerve Blocks in Migraine Prophylaxis

İnan, Nurten; İnan, Levent Ertuğrul; Coşkun, Özlem; Tunç, Tuğba; İlhan, Mustafa

doi:10.5152/npa.2015.10003

Cited by 27 publications

(28 citation statements)

References 19 publications

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“…Even though we are lacking randomized double-blinded comparative study for ON using ONB method, there is well-documented evidence on the efficacy of the ONB as potential management tool for cervicogenic and cluster headaches ( 23 , 24 ). Similarly, new reports about clinical application of local anaesthetic injections for migraine-type headaches are emerging and implying satisfactory outcomes ( 25 , 26 ). This positive effect of ONB applicability in a wide range of headache disorders is exceeding the half-life of local anaesthetics and is attributed to the changes in nociceptive pathways in the brain.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of treatment of occipital neuralgia using the nerve block technique: a prospective analysis of 44 patients

Juškys

Šustickas

2018

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Background.There is a great deal of tools for treatment of occipital neuralgia but currently we are lacking a complete consensus among practitioners regarding the optimal approach to this debilitating condition. Occipital nerve block (ONB) is known as one of the management options but there is lack of scientific literature exploring its effectiveness.Materials and methods.The prospective study was undertaken between March 2014 and February 2018 at the State Vilnius University Hospital. Forty-four patients aged from 28 to 84 years (age mean = 56.30 ± 14.71) of which 79.55% were female (n = 35) were diagnosed with occipital neuralgia (ON) and treated with a local anaesthetic and corticosteroids combination injection into the greater or greater plus lesser occipital nerve (n = 29 and n = 15, respectively) and followed up after 6 months. Analysis of the outcomes of those patients was done by comparing the Visual Analog Scale (VAS) and Barrow Neurological Institute Pain Intensity Score (BNIPIS) prior to treatment, 24 hours after the block, and at a follow-up 6 months later. Analgesic medication consumption before and after 6 months was recorded. A comparison of procedure efficacy in lidocaine and bupivacaine groups was made. Evaluation of block potency for acute and chronic pain categories was conducted as well. The success criteria were defined as patient satisfaction with own condition for at least 6 months, not requiring another block in order to stay comfortable.Results.Of 44 patients, 42 (95.45%) who underwent the occipital nerve block procedure showed satisfactory results for at least 6 months. Mean headache VAS scores decreased from 7.23 ± 0.93 (pre-treatment) to 1.95 ± 1.59 (24 hours after, p < 0.0001) and increased to 2.21 ± 1.73 at the follow-up after 6 months, showing no statistically significant difference between post-interventional and six-month VAS scores (p = 0.07). In all patients the necessity of medication to control pain decreased to 16.67% (n = 7) during the the check-up after 6 months. There was no statistically significant difference in the effectiveness of ONB with regard to the local anaesthetic used or the pain group targeted. Similar results were obtained comparing patients who underwent more than one ONB.Conclusions.Occipital nerve block with a local anaesthetic and corticosteroids provides a safe, simple, and effective treatment method for the patient with medically-refractory occipital neuralgia.

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Section: Discussionmentioning

confidence: 99%

Effectiveness of treatment of occipital neuralgia using the nerve block technique: a prospective analysis of 44 patients

Juškys

Šustickas

2018

AML

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“…However, opinions differ among practitioners regarding the injection point and non‐target specificity, and this is the greatest disadvantage of the classical approach. 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.…”

Section: Discussionmentioning

confidence: 99%

“…A local anesthetic block of the GON, which is very effective, safe and relatively easy to perform, is the most widely used procedure for diagnosing and alleviating the pain of ON (Inan et al ; Kocer, ). 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 ).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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There is no standardized approach to the greater occipital nerve (GON) block technique for treating occipital neuralgia. The aim of the present study was to validate the previously-suggested guidelines for conventional injection techniques and to provide navigational guidelines for safe GON block. The GON, lesser occipital nerve (LON) and occipital artery (OA) were carefully dissected in the occipital region of embalmed cadavers. Using a 3 D digitizer, the GON, LON, and OA were observed on the two reference lines. The distances between the landmarks were recorded and statistically analyzed. On the superior nuchal line, the mean distances between the external occipital protuberance (EOP) and the most medial branch of the GON was 33.5 mm. The mean distance between the EOP and the most medial branch of the OA was 37.4 mm. On the EOP-mastoid process (MP) line, the GON was on the medial third and the LON the lateral third of the EOP-MP line. The safe injection points on the EOP-MP line are about 3 cm from the EOP, 1 cm inferior parallel to the EOP-MP line, and about 3 cm away from the MP. Clin. Anat. 31:1058-1064, 2018. © 2018 Wiley Periodicals, Inc.

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“…The attack frequency decreased from 15.73 (at baseline) to 4.52 (at month 3) in the GON blockade group versus from 13.76 to 3.28 in the GON blockade + prophylactic medication group, whereas headache severity was reduced from 8.26 to 5.16 in the GON blockade group versus from 8.80 to 5.96 in the GON blockade + prophylactic medication group. There were no serious AEs reported [67] (Table 2(b)). An open-label clinical trial of bilateral GON blockade with bupivacaine (2 mL, 0.5%) for the acute treatment of migraine patients with prolonged or persistent aura (n = 18 patients and 22 episodes with aura) revealed that complete response without early recurrence was achieved in 50% (n = 11) and with 24-h recurrence in 9.1% (n = 2) of the cases, whereas partial (greater than 50%) improvement was achieved in 27.3% (n = 6) of the cases.…”

Section: Open-label Studies Of Gon Blockade With Chemical Agents In Emmentioning

confidence: 96%

Therapeutic strategies that act on the peripheral nervous system in primary headache disorders

Tajti

Delia

Nyári

et al. 2019

Expert Review of Neurotherapeutics

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Introduction: Acute and preventive treatment of primary headache disorders is not completely resolved with regard to efficacy, safety, and tolerability. Hence, peripheral and central neuromodulation can provide therapeutic alternatives in drug-resistant cases. Peripheral targets of neuromodulation include invasive and non-invasive neurostimulation and electrical and chemical nerve and ganglion blockades. Areas covered: A PubMed search of papers published from January 2012 to October 2018 was conducted. The goal of this review was to analyze the efficacy and safety of invasive (implantable) peripheral neurostimulation methods (the occipital nerve, the cervical branch of vagal nerve, the sphenopalatine ganglion) and non-invasive (transcutaneous) peripheral neurostimulation methods (the occipital nerve, the supraorbital nerve, and the cervical and auricular branches of the vagal nerve), based on the results of published clinical trials and case series. Acting also on the peripheral nervous system, peripheral nerve (i.e. greater occipital nerve) and ganglion (i.e. sphenopalatine ganglion) blockades, botulinum neurotoxin type A-hemagglutinin complex therapies, and calcitonin generelated peptide-related monoclonal antibody treatments in this patient population are also discussed. Expert opinion: This review summarizes the latest results on the therapeutic strategies acting on the periphery in primary headache disorders. These therapeutic options are minimally invasive or noninvasive, efficacious, safe, and well tolerated. ARTICLE HISTORY

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Effectiveness of Greater Occipital Nerve Blocks in Migraine Prophylaxis

Cited by 27 publications

References 19 publications

Effectiveness of treatment of occipital neuralgia using the nerve block technique: a prospective analysis of 44 patients

Effectiveness of treatment of occipital neuralgia using the nerve block technique: a prospective analysis of 44 patients

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

Therapeutic strategies that act on the peripheral nervous system in primary headache disorders

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