Greater occipital nerve blockade for the treatment of chronic migraine: a randomized, multicenter, double-blind, and placebo-controlled study

İnan, Levent Ertuğrul; İnan, Nurten; Karadaş, Ömer; Gül, Hakan Levent; Erdemoğlu, Ali Kemal; Türkel, Yakup; Akyol, Ali

doi:10.1111/ane.12393

Cited by 129 publications

(149 citation statements)

References 20 publications

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“…In the same year, Inan et al carried out a randomised, double-blind clinical trial to assess GON block effectiveness against placebo in a sample of 84 patients with CM (28). Half received GON block with 1.5 ml bupivacaine 0.5% diluted in 1 ml of saline whilst the other half underwent a sham procedure with saline; the intervention was performed once a week during Pre-and post-intervention parameters are expressed as mean and standard deviation (SD); intra-group differences are expressed by the mean effect size with a 95% confidence interval.…”

Section: Discussionmentioning

confidence: 99%

“…GON blocks with local anaesthetics and/or corticosteroids have been employed for decades in the acute and prophylactic treatment of migraine and other headache disorders (24,25). However, only three randomised, placebo-controlled trials examining the effect of GON blocks in patients with migraine have been published (26)(27)(28); these trials had contradictory conclusions and only one of them was focused on CM.…”

Section: Introductionmentioning

confidence: 99%

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Short-term effects of greater occipital nerve blocks in chronic migraine: A double-blind, randomised, placebo-controlled clinical trial

et al. 2016

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Background Greater occipital nerve (GON) blocks are widely used for the treatment of headaches, but quality evidence regarding their efficacy is scarce. Objective The objective of this article is to assess the short-term clinical efficacy of GON anaesthetic blocks in chronic migraine (CM) and to analyse their effect on pressure pain thresholds (PPTs) in different territories. Participants and methods The study was designed as a double-blind, randomised, placebo-controlled clinical trial. Thirty-six women with CM were treated either with bilateral GON block with bupivacaine 0.5% ( n = 18) or a sham procedure with normal saline ( n = 18). Headache frequency was recorded a week after and before the procedure. PPT was measured in cephalic points (supraorbital, infraorbital and mental nerves) and extracephalic points (hand, leg) just before the injection (T0), one hour later (T1) and one week later (T2). Results Anaesthetic block was superior to placebo in reducing the number of days per week with moderate-or-severe headache (MANOVA; p = 0.027), or any headache ( p = 0.04). Overall, PPTs increased after anaesthetic block and decreased after placebo; after the intervention, PPT differences between baseline and T1/T2 among groups were statistically significant for the supraorbital (T0-T1, p = 0.022; T0-T2, p = 0.031) and infraorbital sites (T0-T1, p = 0.013; T0-T2, p = 0.005). Conclusions GON anaesthetic blocks appear to be effective in the short term in CM, as measured by a reduction in the number of days with moderate-to-severe headache or any headache during the week following injection. GON block is followed by an increase in PPTs in the trigeminal area, suggesting an effect on central sensitisation at the trigeminal nucleus caudalis. This trial is registered at ClinicalTrials.gov (NCT02188394).

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Short-term effects of greater occipital nerve blocks in chronic migraine: A double-blind, randomised, placebo-controlled clinical trial

et al. 2016

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“…The major studies are summarized in Table 1 ( [51][52][53][54][55][56][57][58][59][60][61][62]. Unfortunately, there are very few controlled trials and no standardized methods were used for the selection of migraine patients (some had fixed unilateral headache, others not), the timing of infiltrations (ictal or interictal), the technique of infiltrations or blocks (unilateral or bilateral, association with blocks of other pericranial nerves or trigger point injections, one or more interventions), the compounds used for the blocks (local anesthetics alone or combined with different types and dosages of steroids) and particularly the evaluation of outcomes (number of headache-free days, variable percentage reduction of headache days or attacks, non-uniformly standardized pain indices).…”

Section: Infiltrations/blocks Of Pericranial Nervesmentioning

confidence: 99%

Targeting pericranial nerve branches to treat migraine: Current approaches and perspectives

et al. 2015

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Background: Migraine is a highly prevalent neurological disorders and a major individual and societal burden. Migraine is not curable at the present time, but it is amenable to acute symptomatic and preventive pharmacotherapies. Summary: Since the latter are frequently unsatisfactory, other treatment strategies have been used or are being explored. In particular, interventions targeting pericranial nerves are now part of the migraine armamentarium. We will critically review some of them, such as invasive and noninvasive neurostimulation, therapeutic blocks and surgical decompressions. Conclusions: Although current knowledge on migraine pathophysiology suggests a central nervous system dysfunction, there is some evidence that interventions targeting peripheral nerves are able to modulate neuronal circuits involved in pain control and that they could be useful in some selected patients. Larger, well-designed and comparative trials are needed to appraise the respective advantages, disadvantages and indications of most interventions discussed here.

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“…[6] Olgumuzda da muhtemelen verilen uzun etkili lokal anestezik, miyelinsiz C lifleri ve ağrıya aracılık eden ince miyelinli A delta liflerini geçici ama uzun süreli olarak bloke etmiş ve ağrı yakınmasını azaltmıştır.…”

Section: Pain a Riunclassified

Response of Greater Occipital Nerve Block in Headache Induced by Lacosamide: Report of Case

Akpınar¹

2016

Agri

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Epilepsi yıllık insidans 100.000'de 29-53 iken, prevalansı %0.5-1 olarak toplumda sık bildirilmiştir.[1] Epilepsi hastalarının %30-40'ı medikal tedaviye dirençlidir. Lakozamid (LCM) 2008 yılında on yedi yaş ve üzeri parsiyel başlangıçlı epilepsi hastalarında ekleme tedavisi olarak onaylanan yeni bir üçüncü jenerasyon antiepileptik ilaçtır.[2] Lakozamid kullanımına bağlı sık görülen yan etkiler arasında baş ağrısı alt sıralarda yer alırken, ilaç bırakma nedenleri arasında ise üst sıralardadır.[3] Biz bu yazıda LCM'e bağlı gelişen baş ağrısında büyük oksipital sinir (GON) blokajının etkili olduğu bir olgu sunduk.Otuz iki yaşında kadın hasta nöbet geçirme yakın-masıyla acil servise başvurdu. Nöroloji polikliniğince üç yıldır sekonder jeneralize epileptik nöbet tanısıyla izlenmekte ve valproik asit 1000 mg/gün ile lamotrijin 200 mg/gün tedavisi almakta idi. Nöbet kontrolü sağlanamayan olguya haftalık doz artışlarıyla lakozamid 300 mg/gün başlandı. Daha önceden bilinen bir baş ağrısı öyküsü olmayan hastanın, LCM eklenmesinden sonra baş ağrısı yakınmasının başladığı öğre-nildi. Bu nedenle LCM dozu 200 mg/gün'e düşürüldü. ve baş ağrı yakınması yaklaşık %20 oranında geriledi. Baş ağrısı zonklayıcı, iki taraflı, fotofobi ile fonofobinin eşlik etmediği, süresi 30 dk ile 120 dk arasında değişen ve orta şiddetli özellikteydi. Nöbetlerdeki artış nedeniyle ilaç dozu daha fazla azaltılamadı. Baş ağ-rısı migren tanı kritelerini tam olarak karşılamasada GON blokaj (1 ml bupivakain+1 ml serum fizyolojik) tedavisi (haftalık dozlar halinde dört kez) uygulandı ve visual analog scala (VAS skoru) yaklaşık %50 azaldı. Baş ağrısı ılımlı olarak devam eden olgunun LCM dozunun daha fazla azaltılmasına gerek kalmadı.Lakozamid voltaja bağımlı sodyum kanallarının yavaş inaktivasyonunu artırırarak ve kollapsin yanıtlı mediyatör protein-2'ye bağlanarak etki gösterir. [3] LCM'in yan etkilerinin değerlendirildiği 11 çalışma-da, yan etkilerin sıklık sırası sersemlik hissi (%57), çift görme (%23), yorgunluk (%18), somnalans (%19) olarak saptanırken, %12 olguda yan etkiler nedeniyle tedaviyi bırakılmıştır (3 baş ağrısı, 2 sersemlik hissi, 2 yorgunluk, 2 dengesizlik). [4,5] Literatürde LCM'e bağlı baş ağrısında, ilaç azaltımı dışında bildirilen bir tedavi seçeneğine rastlanılmamıştır.Yapılan çalışmalarda migren, aşırı ilaç kullanımı baş ağrısı, servikojenik baş ağrısı, küme baş ağrısı ve oksipital nevraljide oksipital sinir blokajı ile değişen oranlarda yanıt alınmıştır.[6] Olgumuzda da muhtemelen verilen uzun etkili lokal anestezik, miyelinsiz C lifleri ve ağrıya aracılık eden ince miyelinli A delta liflerini geçici ama uzun süreli olarak bloke etmiş ve ağrı yakınmasını azaltmıştır.

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Greater occipital nerve blockade for the treatment of chronic migraine: a randomized, multicenter, double-blind, and placebo-controlled study

Cited by 129 publications

References 20 publications

Short-term effects of greater occipital nerve blocks in chronic migraine: A double-blind, randomised, placebo-controlled clinical trial

Short-term effects of greater occipital nerve blocks in chronic migraine: A double-blind, randomised, placebo-controlled clinical trial

Targeting pericranial nerve branches to treat migraine: Current approaches and perspectives

Response of Greater Occipital Nerve Block in Headache Induced by Lacosamide: Report of Case

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