Greater occipital nerve block in migraine prophylaxis: Narrative review

İnan, Levent Ertuğrul; İnan, Nurten; Unal-Artık, Hanzade Aybuke; Ataç, Ceyla; Babaoğlu, Gülçin

doi:10.1177/0333102418821669

Cited by 48 publications

(62 citation statements)

References 33 publications

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“…A recent review by Inan et al in 2019 evaluated the role of GON block in migraine prophylaxis but did not focus on CM only. 30 They reviewed 14 trials, 7 of which were randomized controlled trials (RCTs). Of these, 5 had placebo-controlled arms and 2 studied the effects of addition of steroids to GON block.…”

Section: Introductionmentioning

confidence: 99%

Role of greater occipital nerve block for preventive treatment of chronic migraine: A critical review

Chowdhury

Mundra

2020

Cephalalgia Reports

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Objective: The aim of this study is to critically analyze the evidence of the efficacy and safety of greater occipital nerve (GON) block for the preventive treatment of chronic migraine (CM). Background: A rigorous scientific assessment of efficacy and safety of the GON block for preventive treatment in CM is not available. This critical review was undertaken for this purpose. Methods: References for this review were identified by searches of articles published in the English language in PubMed between 1969 and April 15, 2020 using “greater occipital nerve block,” “chronic migraine,” “migraine,” “headache,” and “treatment” as keywords. Results: Out of potential 532 articles, 9 open-label and 4 placebo-controlled trials that studied the role of GON block for prevention of CM were identified and reviewed. Open-label trials reported a reduction of headache severity and frequency in 35–68% of patients. The beneficial effect of a single block lasted up to 4 weeks. Randomized controlled trials (RCTs) used varied methodology and techniques of GON block and the outcomes were reported at different time points. A single RCT showed a beneficial effect of the GON block at 1 week. However, the GON block was found to be safe and well tolerated. Conclusion: Long-term efficacy of GON block in CM shall need further well-designed RCTs using standardized methodology. This study, in addition, reviewed the limitations and uncertainties regarding the technique and methods of use of GON block in CM.

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Section: Introductionmentioning

confidence: 99%

Role of greater occipital nerve block for preventive treatment of chronic migraine: A critical review

Chowdhury

Mundra

2020

Cephalalgia Reports

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“…In one study, large occipital nerve blockade was performed for chronic migraine, tension-type headache and cervicogenic headache, and a significant reduction in pain intensity was observed in patients with chronic migraine. (12).…”

Section: Current Medical Research and Opinionmentioning

confidence: 99%

Peripheral Nerve Blockade and Botox Treatment in Chronic Migraine: A Comparative Study

Bilgiç¹,

Akpınar²,

Börü

et al. 2021

J Current Med Res Opinion

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Migraine is the most commonly encountered disabling headache. Chronic migraine significantly affects the quality of life and reduces the ability to attend work and social events, and consequently becomes an increasing economic burden.In recent years, peripheral nerve block with botulinum toxin A (botox) and local analgesics has been included in alternative treatment regimens.In cases of chronic migraine, botox is injected into the facial area, maxillary and mandibular nerve, and the head and neck muscles.Recent methods such as great occipital nerve (GON), and lesser occipital nerve, supra orbital nerve (SON), sphenopalatine ganglion blockade and trigeminal ganglion blockade have been applied using local analgesics. GON and SON blockade are the most frequently used of these methods. Studies related to these methods have shown a decrease in the frequency and severity of migraine pain.The results of this study showed that both GON and SON blockade and long-term application of BTX-A treatment were highly effective in the treatment of chronic migraine and both treatment methods had a similar level of effectiveness.That the follow-up period of this study was longer than in previous research can be considered a strong aspect of the study.

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“…This connection of the trigeminal and occipital/ cervical system is the mechanistic justification for blocking the greater occipital nerve (GON-block) as a treatment option for headache patients. This has long been utilised in clinical practice for primary headaches such as cluster headache (12), but there is conflicting evidence for its efficacy in migraine (13). Open trials have reported some reduction in frequency and intensity of attacks (14)(15)(16)(17).…”

Section: Introductionmentioning

confidence: 99%

Predicting the outcome of the greater occipital nerve block – an observational study on migraine patients with and without musculoskeletal cervical impairment

et al. 2020

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Background and objective The importance of neck pain and the trigeminocervical complex in migraine is of high pathophysiological interest since a block to the greater occipital nerve is more effective for some primary headaches than others. This observational study hypothesised that the response to manual palpation of the upper cervical spine predicts the efficacy of the greater occipital nerve-block. Methods We divided patients, scheduled by a neurologist to receive a greater occipital nerve-block to reduce their migraine symptoms, into three groups: Patients with no pain response to manual palpation of the neck, patients with local pain, and those with referred pain to the head. Primary outcome was the percentage change in headache frequency. Additionally, items from the quantitative sensory testing protocol were included. Results Eighty-seven chronic migraine patients were recruited consecutively from a specialised outpatient clinic and 71 were included for analyses and stratified into the three groups: No pain (n = 11), local pain (n = 28), and referred pain to the head (n = 32). Overall, patients experienced a reduction of 1.9 headache days per month (SD 3.4, p < 0,0001). The groups differed significantly in the percentage change of headache frequency ( p = 0.041) with the “no pain” group showing the largest reduction. The pressure-pain-threshold over C2 and headache on the day of the intervention influenced the outcome significantly (R2 0,27, p = 0,00078). No serious adverse events occurred. Sixty-five percent of the patients had headaches during the examination. The groups did not differ regarding the distribution of patients with neck-pain in absence of migraine at baseline ( p = 0.618). Conclusion Patients that were less sensitive to palpation in the cervical region and headache-free on the day of the intervention improved more after the greater occipital nerve-block. Registration: Registered a priori at the German Clinical Trials Register (DRKS00015995).

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Greater occipital nerve block in migraine prophylaxis: Narrative review

Cited by 48 publications

References 33 publications

Role of greater occipital nerve block for preventive treatment of chronic migraine: A critical review

Role of greater occipital nerve block for preventive treatment of chronic migraine: A critical review

Peripheral Nerve Blockade and Botox Treatment in Chronic Migraine: A Comparative Study

Predicting the outcome of the greater occipital nerve block – an observational study on migraine patients with and without musculoskeletal cervical impairment

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