Efficacy and safety of greater occipital nerve block for the treatment of cervicogenic headache: a systematic review

Caponnetto, Valeria; Ornello, Raffaele; Frattale, Ilaria; Felice, Chiara Di; Pistoia, Francesca; Lancia, Loreto; Sacco, Simona

doi:10.1080/14737175.2021.1903320

Cited by 7 publications

(5 citation statements)

References 20 publications

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“…Anesthetics, corticosteroids, or both, are injected to reduce the sensation of pain afferent fibers to the trigeminal ganglia. Similarly, some studies have demonstrated GON blocks to be efficacious in cervicogenic headaches, which are caused by lesions in the cervical spine or soft tissue of the neck [3] .…”

Section: Discussionmentioning

confidence: 96%

“…Historically, greater occipital nerve (GON) blocks and radiofrequency ablations have been efficacious in the treatment of refractory migraines, cervicogenic headaches, and occipital neuralgia[ [1] , [2] , [3] , 6 ]. The underlying strategy is to block cutaneous innervation to the posterior scalp which is largely supplied by the GON.…”

Section: Discussionmentioning

confidence: 99%

“…Greater occipital nerve blocks have been well described in the literature in the treatment of refractory occipital neuralgia, migraines, and cervicogenic headaches [1] , [2] , [3] . Likewise, greater occipital nerve ablation may result in more long-term relief in these conditions [4] , [5] , [6] .…”

Section: Introductionmentioning

confidence: 99%

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Refractory occipital scalp pruritus treated with computed tomography-guided greater occipital nerve ablation

Rosenthal

AuYong

Swerlick

et al. 2022

Radiology Case Reports

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Greater occipital nerve blocks and thermal ablations have been widely discussed as an efficacious treatment strategy for multiple difficult to treat conditions, including occipital neuralgia, migraines, and cervicogenic headaches. Nerve blocks have also recently been presented as a method of treating neuropathic itch in the upper extremities, where pruritus occurs without visible dermatologic manifestations. We report a case of refractory occipital scalp pruritus in a patient who had excellent although time-limited response to greater occipital nerve blocks but achieved durable symptom control with CT-guided greater occipital nerve ablation.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Refractory occipital scalp pruritus treated with computed tomography-guided greater occipital nerve ablation

Rosenthal

AuYong

Swerlick

et al. 2022

Radiology Case Reports

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“…Greater occipital nerve block (GONB) is an effective treatment in migraine (Allen et al, 2018 ; Gawel & Rothbart, 1992 ; Malekian et al, 2021 ; Tang et al, 2017 ; Zhang et al, 2018 ), cervicogenic headache (Anthony, 2000 ; Caponnetto et al, 2021 ; Inan et al, 2001 ; Lauretti et al, 2015 ), and occipital neuralgia (Anthony, 1992 ; Ashkenazi et al, 2007 ; Ashkenazi & Levin, 2004 ; Newman & Levin, 2008 ), which are among the causes of headache. The greater occipital nerve (GON) is the medial branch of dorsal ramus of second cervical spinal nerve (Standring, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

Morphological features of the greater occipital nerve and its possible importance for interventional procedures

Saglam,

Gayretli,

Coskun

et al. 2023

Journal of Anatomy

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Being one of the most prevalent neurological symptoms, headaches are burdensome and costly. Blocks and decompression surgeries of the greater occipital nerve (GON) have been frequently used for migraine, cervicogenic headache, and occipital neuralgia which are classified under headache by International Headache Society. Knowledge of complex anatomy of GON is crucial for its decompression surgery and block. This study was performed to elucidate anatomical features of this nerve in detail. Forty‐one cadavers were dissected bilaterally. According to its morphological features, GON was classified into four main types that included 18 subtypes. Moreover, potential compression points of the nerve were defined. The number of branches of the GON up to semispinalis capitis muscle and the number of its branches that were sent to this muscle were recorded. The most common variant was that the GON pierced the aponeurosis of the trapezius muscle, curved around the lower edge of the obliquus capitis inferior muscle, and was loosely attached to the obliquus capitis inferior muscle (Type 2; 61 sides, 74.4%). In the subtypes, the most common form was Type 2‐A (44 sides, 53.6%), in which the GON pierced the aponeurosis of each of the trapezius muscle and fibers of semispinalis muscle at one point and there was a single crossing of the GON and occipital artery. Six potential compression points of the GON were detected. The first point was where the nerve crossed the lower border of the obliquus capitis inferior muscle. The second and third points were at its piercing of the semispinalis capitis muscle and the muscle fibers/aponeurosis of the trapezius, respectively. Fourth, fifth, and sixth compression points of GON were located where the GON and occipital artery crossed each other for the first, second, and third times, respectively. On 69 sides, 1–4 branches of the GON up to the semispinalis capitis muscle were observed (median = 1), while 1–4 branches of GON were sent to the semispinalis capitis muscle on 67 sides (median = 1). The novel anatomical findings described in this study may play a significant role in increasing the success rate of invasive interventions related with the GON.

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“…11 Often through trial and error, pharmacotherapy and spinal nerve blocks can provide temporary relief of pain and improve function resulting in only modest symptom improvemements. [12][13][14] Another common intervention is exercise therapy, which focuses on addressing associated physical mobility, strength or endurance impairments of the neck and scapulothoracic regions. [15][16][17][18][19] In an early seminal trial for CGH, participants receiving speci c motor control exercises had signi cantly reduced headache frequency and intensity, with associated reduction in neck pain 15 However, other studies have shown little or no effect.…”

mentioning

confidence: 99%

The Safety and Feasibility of Transcranial Direct Current Stimulation Combined with Conservative Treatment for Cervicogenic Headaches: A double-blinded randomized control study

Jobin

Campbell

Schabrun

et al. 2022

Preprint

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Background Cervicogenic headaches (CGH) are common following concussion and whiplash injuries and significantly reduce patient quality of life. CGH is often associated with neck, jaw and/or facial pain and reduced neck mobility. Conservative therapy and injection-based therapies are cornerstones of treatment for CGH but have shown limited efficacy. Transcranial direct current stimulation (tDCS) over the primary motor cortex (M1) has shown promise in treating other chronic pain and headache conditions. The primary aim of this trial is to evaluate the feasibility and safety of tDCS when combined with conservative therapy for the treatment of CGH. The study will evaluate retention and dropout rates, adherence to the protocol and adverse events. Exploratory aims will investigate the association of CGH and various health outcomes, inclusive of pain intensity, headache frequency and duration, neck mobility, quality of life, pain sensitivity, and medication usage. Methods Forty adults (aged 18–65), blinded to treatment arm, will be randomized into one of two groups: active tDCS with conservative therapy or sham tDCS with conservative therapy. tDCS will be applied over M1 by a trained research assistant three times per week for 6 weeks. Conservative therapy will be provided immediately post-tDCS. The primary outcomes of this trial will be the feasibility and safety of this intervention. Feasibility will be defined as greater than 30% recruitment, greater than 70% protocol adherence, and greater than 70% retention rate. Safety will be defined as no severe adverse events and less than 30% increase in adverse effects. Secondary exploratory outcomes will be assessed using the following: numeric pain rating scale (NPRS), headache impact test-6 (HIT-6), rivermead PPCS questionnaire (RPQ), cranio-cervical flexion test (CCFT), cervical extensor endurance test (CEET), cervical flexor endurance test (CFET), dynamometry neck-strength assessment (DNSA), the European quality of life five dimension (EQ-5D), patient reported outcomes measurement information system (PROMIS) pain interference scale, pain catastrophizing scale (PCS), and section A - quantitative analgesics questionnaire (QAQ-A). Discussion This pilot study will be the first to evaluate the use of tDCS combined with conservative therapy for the treatment of cervicogenic headaches. Trial Registration: ClinicalTrials.gov - NCT05582616 (registered October 4th, 2022) https://clinicaltrials.gov/ct2/show/NCT05582616

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Efficacy and safety of greater occipital nerve block for the treatment of cervicogenic headache: a systematic review

Cited by 7 publications

References 20 publications

Refractory occipital scalp pruritus treated with computed tomography-guided greater occipital nerve ablation

Refractory occipital scalp pruritus treated with computed tomography-guided greater occipital nerve ablation

Morphological features of the greater occipital nerve and its possible importance for interventional procedures

The Safety and Feasibility of Transcranial Direct Current Stimulation Combined with Conservative Treatment for Cervicogenic Headaches: A double-blinded randomized control study

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