Efficacy of the Greater Occipital Nerve Block for Cervicogenic Headache: Comparing Classical and Subcompartmental Techniques

Lauretti, Gabriela Rocha; Corrêa, Selma W. R. O.; Mattos, Anita Leocádia de

doi:10.1111/papr.12228

Cited by 47 publications

(42 citation statements)

References 18 publications

(33 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Injection by using an anatomic landmark-based approach is the most commonly performed technique that involves injecting medication at the level of the superior nuchal line, medial to the palpated occipital artery 17. Fluoroscopic guidance has also been used to identify the pertinent bony landmarks in an attempt to improve accuracy 18. Using a palpation- or fluoroscopy-based technique often requires injection of greater volumes of local anesthetic, which increases the risk of unintentionally blocking adjacent nerves (lesser occipital nerve, third occipital nerve), and therefore limiting the diagnostic utility of the injection.…”

Section: Introductionmentioning

confidence: 99%

Comparison of two ultrasound-guided techniques for greater occipital nerve injections in chronic migraine: a double-blind, randomized, controlled trial

Flamer

Alakkad

Soneji

et al. 2019

Regional Anesthesia &Amp; Pain Medicine

View full text Add to dashboard Cite

Background and objectivesTwo ultrasound (US)-guided techniques for greater occipital nerve (GON) block have been described for the management of headache disorders: a “proximal or central” technique targeting the GON at the level of the second cervical vertebra and a “distal or peripheral” technique targeting the GON at the level of the superior nuchal line. In this multicenter, prospective, randomized control trial, we compared accuracy, effectiveness, and safety of these two techniques in patients with chronic migraines (CMs).MethodsForty patients with refractory CMs were randomized to receive either a proximal or distal US-guided GON block with bupivacaine and methylprednisolone acetate. The primary outcome was the difference in Numerical Rating Score (NRS) for headache intensity at 1 month. Secondary outcomes were effectiveness, performance, and safety-related. Effectiveness-related outcomes included NRS for headache intensity, number of headache days per week, patient satisfaction, quality of life, assessment of sleep quality, and sleep interruption. Performance-related outcomes included procedure time, accuracy of block, and patient discomfort. Safety-related outcomes included an assessment for adverse effects.ResultsNRS pain scores were significantly reduced at 24 hours and at 1 week postprocedure in both cohorts and at 1 and 3 months in the proximal group as compared with the baseline. There was no significant difference in NRS pain scores between the two cohorts at any of the follow-up time points. There was a significant reduction in number of headache days per week at 1 month in both groups, and a significant improvement in sleep interruption at 1 week in both groups. There were no significant adverse effects.ConclusionsThis study was designed to compare two different US-guided approaches for blocking the GON. Our results demonstrate that both distal and proximal techniques can provide a short-term improvement in headache intensity, reduction in number of headache days per week, and an improvement in sleep interruption. The proximal GON technique may confer more sustained analgesic benefit compared with the distal approach in patients with CM headaches.Trial registration number NCT02031822.

show abstract

Section: Introductionmentioning

confidence: 99%

Comparison of two ultrasound-guided techniques for greater occipital nerve injections in chronic migraine: a double-blind, randomized, controlled trial

Flamer

Alakkad

Soneji

et al. 2019

Regional Anesthesia &Amp; Pain Medicine

View full text Add to dashboard Cite

show abstract

“…6 Moreover, GON blocks have shown efficacy in the diagnosis and treatment of cervicogenic headache. [7][8][9] Many practitioners perform GON injections using a conventional approach, relying solely on superficial bone-based anatomic landmarks to infiltrate local anesthetic and corticosteroid around the nerve at the level of the superior nuchal line. Some clinicians also use fluoroscopy to confirm the location of bony landmarks.…”

mentioning

confidence: 99%

“…Some clinicians also use fluoroscopy to confirm the location of bony landmarks. 7 The ambiguity of these injections poses a risk of anesthetizing adjacent structures or injecting into vessels, such as the occipital artery. 5 Very limited research has been done to quantify the risk of these injections, but a complication rate of 5% to 10% has been reported, including headache, dizziness, blurred vision, and syncope.…”

mentioning

confidence: 99%

Clinical Efficacy of an Ultrasound-Guided Greater Occipital Nerve Block at the Level of C2

Pingree

Sole

Brien

et al. 2017

Regional Anesthesia and Pain Medicine

View full text Add to dashboard Cite

This prospective open-label study demonstrated successful blockade of the GON at the level of C2 using a novel ultrasound-guided technique. Significant reductions in pain scores were observed over the 4-week study period, and no adverse events were reported. The observations from this study provide important preliminary data for future randomized trials involving patients with occipital neuralgia and cervicogenic headache.

show abstract

“…The benefits of physical treatments, cervical epidural steroid injections, and botulinum toxin for the treatment of CH have been reported previously (13,14,15). Prior studies relating to the treatment of CH have shown that local steroid injection for CH are effective (6,7,8,16). Despite the fact that injection of steroid in the GON is a valid and less destructive interventional treatment option, definitive evidence is lacking.…”

Section: Discussionmentioning

confidence: 99%

“…Early studies including different types of study designs reported an improved control of CH pain after GON blocks (6,7,8). To date, however, there are no similarly well-known GON injection protocols for the treatment of CH.…”

Section: Introductionmentioning

confidence: 99%

The Effects of Repetitive Greater Occipital Nerve Blocks on Cervicogenic Headache

Ertem¹,

Yılmaz²

2019

tnd

View full text Add to dashboard Cite

Objective: The clinical features of cervicogenic headache (CH) are characterized by unilateral, dull headache; precipitated by neck movements or external pressure over the great occipital nerve (GON). No conservative therapies have been proved to be effective for the management of CH. The purpose of this study was to assess the effects of interventional pain management, including repetitive anesthetic block using lidocaine and methylprednisolone GON injections for local pain and associated headache. Materials and Methods: This retrospective cohort study was undertaken between January 2016 and December 2017. Twenty-one patients with CH were evaluated in our headache clinic during the study period. The diagnosis of CH was made according to International Classification of Headache Disorders 3 rd edition beta version. The socio-demographic and clinical characteristics were recorded for all patients who underwent at least 3 GON blocks and attended at least 4 follow-up appointments. Change in the Numeric Pain Rating Scale (NPRS) was used to assess the response to GON blocks. SPSS 23.0 was used as the statistical analysis program. Results: The mean age of patients was 61.51±13.88 years; 42.85% were female. The duration of headache was 30.81±21.95 years. Eighty-five percent of patients had unilateral headache. Ten patients had myofascial spasm (trigger points) located in neck, occipitalis, and temporalis muscles. Sixty-six percent of patients reported headache following head trauma. From 3-months post treatment, a significant decrease in NPRS (p<0.001) was identified. The number of headaches was reduced significantly at three months (p<0.001) No serious complications were noted. The coexistence of myofascial spasms, history of trauma and additional headache had no significant effect on NPRS score improvements (p>0.05). Conclusion: The results of this study demonstrated that repetitive greater occipital blocks may be an effective option for the management of CH and contribute to significant reductions in pain severity scores at 3 months following injection.

show abstract

Efficacy of the Greater Occipital Nerve Block for Cervicogenic Headache: Comparing Classical and Subcompartmental Techniques

Abstract: While the classical technique for GON block resulted in only 2 weeks of analgesia, the subcompartmental technique resulted in at least 24 weeks of analgesia, being 5 mL volume sufficient for the performance of the block under fluoroscopy.

Cited by 47 publications

References 18 publications

Comparison of two ultrasound-guided techniques for greater occipital nerve injections in chronic migraine: a double-blind, randomized, controlled trial

Comparison of two ultrasound-guided techniques for greater occipital nerve injections in chronic migraine: a double-blind, randomized, controlled trial

Clinical Efficacy of an Ultrasound-Guided Greater Occipital Nerve Block at the Level of C2

The Effects of Repetitive Greater Occipital Nerve Blocks on Cervicogenic Headache

Contact Info

Product

Resources

About