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

Abstract

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.

A Review of the Recent Findings in Minimally Invasive Treatment Options for the Management of Occipital Neuralgia

“…There was no statistically significant difference in pain scores with lidocaine vs. bupivacaine, demonstrating that the local anesthetic does not affect the efficacy of occipital nerve blocks. All of the nerve blocks were well tolerated except for one patient who experienced transient dizziness and nausea [25]. A case series consisting of three patients with occipital neuralgia secondary to sports-related concussion yielded similar results.…”

Regional Anesthesia For Postdural Puncture Headache (PDPH): A New Solution For An Old Problem? A Systemic Review.

“…It innervates the skin of the occipital region up to the vertex, together with the lesser occipital nerve. 44 The GON is the main sensory nerve of the occipital area and is involved in various pain syndromes such as occipital neuralgia, 45 cervicogenic headaches, 46 and migraines. 47 The GONB consists on injection of local anesthetic medial to the occipital artery at the level of the superior nuchal line (SNL), i.e.…”

High-Resolution Ultrasound of Small Clinically Relevant Nerves Running Across the Posterior Triangle of the Neck

“…LON blockage, possibly guided by US, is increasingly performed for the treatment of patients with occipital headache. 66 The GAN is a pure sensory nerve formed by the anterior division of the C2 and C3 roots. It winds around the posterior margin of the SCM approximately at its middle third, close to the point of emergence of the LON and TCN, in an area commonly referred to as Erb's point (►Fig.…”