Efficacy and safety of greater occipital nerve block for the treatment of cluster headache: a systematic review and meta-analysis

Repeated greater occipital nerve injections with corticosteroids in medically intractable chronic cluster headache: a retrospective study

“…Patients with MICCH reported a clinically relevant improvement after 69% of first GON-injections, 68% of second injections and 82% of third injections. These results are in line with other studies reporting response rates in mixed groups (ECH and CCH) between 42 and 96% [2,3,[5][6][7][8][9][10][11][12].…”

“…Currently, the most plausible mechanism of action is modification of trigeminal nociceptive transmission through reduced transmission in normal unmyelinated C-fibres [14]. Furthermore, since mechanism of action of different corticosteroids is presumably similar, no difference in effect between type of corticosteroid should be expected, as demonstrated by previous studies obtaining comparable results with different injection compounds [2].…”

“…Greater occipital nerve (GON) infiltration with corticosteroids ('GON-injection') has been shown to be efficacious in ECH in multiple observational studies and two double-blind, placebo-controlled trials, with only mild, local side effects [2]. Since beneficial effects appear to last weeks to months, a one-time GON-injection or a single treatment cycle (from here on referred to as single GON-injection) seems mostly suitable for episodic cluster headache and has therefore been sparsely described in a well-documented group of MICCH patients [3].…”

“…Since beneficial effects appear to last weeks to months, a one-time GON-injection or a single treatment cycle (from here on referred to as single GON-injection) seems mostly suitable for episodic cluster headache and has therefore been sparsely described in a well-documented group of MICCH patients [3]. Furthermore, consensus on injection compound, volume, number of injections in a single treatment cycle, and, in the case of repeated treatments, injection interval, has not yet been reached [2]. As such, (repeated) GON-injection has not yet found its place in current (inter)national treatment protocols for MICCH and is often only used as a last-resort treatment in a very limited number of headache centres in a trial-and-error approach.…”

The Promising Effect of Nerve Decompression in Trigeminal Autonomic Cephalalgias: Report of Case Series

“…With respect to published studies, peripheral nerve block and nerve stimulation, mainly for the supraorbital and greater occipital nerves ( 3 , 6 , 7 ), have been effective in the treatment of paroxysmal hemicrania and hemicrania continua. Previously, it was shown that greater occipital nerve block with steroids significantly improved cluster headache ( 12 , 13 ). Nerve blocks, however, have transient efficacy, and there are potential complications with nerve stimulators.…”