Greater Occipital Nerve Blockade for Cluster Headache

Magnoux, Eric

doi:10.1111/j.1468-2982.2003.00659.x

Cited by 4 publications

(4 citation statements)

References 2 publications

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“…This finding confirmed previous observations, but needs to be replicated in controlled trials. Also, suboccipital injection of long‐acting steroids was shown to be effective in the prophylaxis of cluster headache in a double‐blind, placebo‐controlled trial [103,104]. If all drug treatment procedures are ineffective and a secondary cluster headache has been excluded, surgical treatment can be discussed with the patient.…”

Section: Interventional and Surgical Treatmentmentioning

confidence: 99%

EFNS guidelines on the treatment of cluster headache and other trigeminal‐autonomic cephalalgias

May

Leone

Áfra³

et al. 2006

Euro J of Neurology

376

381

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Cluster headache and the other trigeminal-autonomic cephalalgias [paroxysmal hemicrania, short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) syndrome] are rare but very disabling conditions with a major impact on the patient's quality of life. The objective of this study was to give evidence-based recommendations for the treatment of these headache disorders based on a literature search and consensus amongst a panel of experts. All available medical reference systems were screened for any kind of studies on cluster headache, paroxysmal hemicrania and SUNCT syndrome. The findings in these studies were evaluated according to the recommendations of the European Federation of Neurological Societies resulting in level A, B or C recommendations and good practice points. For the acute treatment of cluster headache attacks, oxygen (100%) with a flow of at least 7 l/min over 15 min and 6 mg subcutaneous sumatriptan are drugs of first choice. Prophylaxis of cluster headache should be performed with verapamil at a daily dose of at least 240 mg (maximum dose depends on efficacy or tolerability). Although no class I or II trials are available, steroids are clearly effective in cluster headache. Therefore, the use of at least 100 mg methylprednisone (or equivalent corticosteroid) given orally or at up to 500 mg i.v. per day over 5 days (then tapering down) is recommended. Methysergide, lithium and topiramate are recommended as alternative treatments. Surgical procedures, although in part promising, require further scientific evaluation. For paroxysmal hemicranias, indomethacin at a daily dose of up to 225 mg is the drug of choice. For treatment of SUNCT syndrome, large series suggest that lamotrigine is the most effective preventive agent, with topiramate and gabapentin also being useful. Intravenous lidocaine may also be helpful as an acute therapy when patients are extremely distressed and disabled by frequent attacks. ObjectivesThese guidelines give evidence-based recommendations for the treatment of cluster headache, paroxysmal hemicranias and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) syndrome. A brief clinical description of the headache disorders is included. The headache disorders are defined based on the diagnostic criteria of the International Headache Society (IHS) [1].

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Section: Interventional and Surgical Treatmentmentioning

confidence: 99%

EFNS guidelines on the treatment of cluster headache and other trigeminal‐autonomic cephalalgias

May

Leone

Áfra³

et al. 2006

Euro J of Neurology

376

381

View full text Add to dashboard Cite

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“…Bu tedavi yönteminin, kronik ağrıların tedavisinde potansiyel bir rol oynayabileceğine dair kanıtlar mevcuttur (10)(11)(12). Literatürde Küme tipi baş ağrılarının tedavisinde Sfenopalatin fossaya uygulanan lidokain solüsyonunun ve Oksipital sinir blokajı gibi periferik nöral blokajların küme tipi baş ağrısı semptomlarını rahatlatmada etkili olduğuna dair yayınlar mevcuttur (13)(14)(15)(16). Yine, subkutan veya intravenöz uygulanan lidokainin baş ağrısı ve trigeminal otonomik sefaljilerin tedavisinde etkili olabileceği bildirilmiştir (17)(18)(19)(20).…”

Section: Discussionunclassified

Treatment Of Episodic Cluster Headache With Neural Therapy: A Case Report

Demir Uşan,

Ciftçi,

Genç

et al. 2023

Journal of Anatol Medicine

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Küme baş ağrısının hipotalamus, trigeminovasküler sistem ve otonom sinir sisteminde senkronize anormal bir aktivite sonucu ortaya çıktığı düşünülen ve genellikle aşırı derecede ağrılı seyreden tek taraflı, özellikle orbital bölgede yoğunlaşan baş ağrısı atakları ile karakterize bir trigeminal otonomik sefaljidir. Akut atak tedavisinde ve proflaktik tedavide oksijen tedavisi, çeşitli medikal tedavi yaklaşımlar ve girişimsel tedavi yöntemleri kullanılmakla birlikte bazı vakalar tüm tedavilere direnç gösterebilmektedir. Bu makalede, Hemanjioblastom operasyonu sonrasında gelişen uyuşukluk ve ardından ortaya çıkan şiddetli baş ağrıları yaşayan 36 yaşındaki erkek hastanın nöralterapi ile etkin bir şekilde tedavi edilmesine yer verilmiştir. Nöralterapi tedavisi, hastanın semptomlarını tamamen ortadan kaldırmış ve iki yıllık takip sürecinde atakların tekrarlamadığı gözlenmiştir.Cluster headache is a trigeminal autonomic cephalgia, which is thought to occur as a result of synchronous abnormal activity in the hypothalamus, trigeminovascular system and autonomic nervous system, and is characterized by unilateral, especially intensely concentrated in the orbital region, headache attacks that are usually extremely painful. Although oxygen therapy, various medical treatment approaches and interventional treatment methods are used in acute attack and prophylactic treatment, some cases may show resistance to all treatments. In this article, the effective treatment of a 36-year-old male patient with drowsiness and severe headaches after hemangioblastoma operation with neural therapy is discussed. Neural therapy treatment completely eliminated the patient's symptoms, and it was observed that the attacks did not recur in a two-year followup period.

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“…Though the GON spreads into several highly variable branches which serve the skin of the occiput, its common trunk generally takes a constant course until leaving the fascia of the m. trapezius (26,27). Landmarks have been proposed before where anaesthetic blocks can be applied to infiltrate the GON (8,28). In chronic CH this infiltration helps to interrupt or relieve episodes of cluster attacks (29)(30)(31).…”

Section: Discussionmentioning

confidence: 99%

“…Despite intensified treatment and combination of prophylactic medications, a certain number of patients cannot satisfactorily control their CH attacks or suffers from severe side effects of the drugs (7). In some, occipital blocks may prove helpful (8). For refractory patients an invasive treatment of the cluster headache is proposed (9,10).…”

Section: Patients Collectivementioning

confidence: 99%

Stimulation of the Greater Occipital Nerve: Anatomical Considerations and Clinical Implications

Mueller

Hagel²,

Wrede³

et al. 2013

Pain Phys

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Background: Stimulation of the greater occipital nerve has been employed for various intractable headache conditions for more than a decade. Still, prospective studies that correlate stimulation of the greater occipital nerve with outcome of patients with respect to alleviation of headache are sparsely found in literature. Objective: To identify anatomical landmarks for a reproducible stimulation of the greater occipital nerve. For the clinical implication, the individual response to therapy of patients with refractory chronic cluster headache undergoing occipital nerve stimulation was correlated with the postoperative localization of the electrodes and with the distribution of the stimulation field. Study Design: Prospective observational study, approved by the local research ethics board (09-4143). Setting: University hospital, departments of neurosurgery and neurology, institute of anatomy and radiology. Methods: Ten formaldehyde fixed human cadavers were dissected to identify the passage of the greater occipital nerve through the trapezius muscle. The distance to the external occipital protuberance was triangulated measuring the distance of the nerve from the nuchal midline and the protuberance. Between December 2008 and December 2011, 21 consecutive patients suffering from chronic cluster headache underwent surgery in terms of bilateral occipital nerve stimulation, with electrodes placed horizontally at the level of C1. The postoperative x-rays were compared with the acquired landmarks from the anatomical study. The distribution of the stimulation field was correlated to the individual response of each patient to the therapy and prospectively analyzed with regard to reduction of daily cluster attacks and relief of pain intensity at 3 months and at last follow-up. Results: The greater occipital nerve crosses the trapezius muscle at a mean distance of 31mm below the occipital external protuberance and 14mm lateral to the midline as found in the anatomical subjects. The electrodes were targeted at this level in all of our patients and stimulated the greater occipital nerve in all patients. Eighteen of the patients (85.7%) reported a significant reduction of the frequency of their cluster attacks and/or declined intensity of pain during the attacks. Yet, 3 of 21 patients (14.3%) did not benefit from the stimulation despite an adequate spread of the stimulation over the occiput. The spread of the stimulation-induced paraesthesias over the occiput was not correlated to a reduction of cluster attacks, to the intensity of attacks, or to the response to treatment at all. Limitations: Single center non-randomized non-blinded study. Conclusions: From our study we conclude that a reproducible stimulation of the greater occipital nerve can be achieved by placing the electrodes parallel to the atlas, at about 30mm distance to the external occipital protuberance. The response to the stimulation is not correlated to the field width of the paraesthesia. We, therefore, consider stimulation of the main trunk of the greater occipital nerve to be more important than a large field of stimulation on the occiput. Still, an individual response to the occipital nerve stimulation cannot be predicted even by optimal electrode placement. Key words: Greater occipital nerve, occipital nerve stimulation, anatomical study, chronic cluster headache

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Greater Occipital Nerve Blockade for Cluster Headache

Cited by 4 publications

References 2 publications

EFNS guidelines on the treatment of cluster headache and other trigeminal‐autonomic cephalalgias

EFNS guidelines on the treatment of cluster headache and other trigeminal‐autonomic cephalalgias

Treatment Of Episodic Cluster Headache With Neural Therapy: A Case Report

Stimulation of the Greater Occipital Nerve: Anatomical Considerations and Clinical Implications

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