Greater occipital nerve blocks in chronic cluster headache: a prospective open‐label study

Lambru, Giorgio; Bakar, Norazah Abu; Stahlhut, L.; McCulloch, Scott; Miller, Sarah; Shanahan, Paul; Matharu, Manjit

doi:10.1111/ene.12321

Cited by 87 publications

(85 citation statements)

References 11 publications

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“…15,19,40 In one study evaluating service members evacuated from Operations Iraqi and Enduring Freedom with headaches, 4.9% were given a primary diagnosis of ON. 15 However, these statistics may belie the socioeconomic burden of conditions that may respond to interventions targeting the occipital nerve(s), as approximately 50% of migraineurs, 2,5,6,11,23,48 a majority of individuals with cluster headache, 2,4,23,37,45 and significant proportions of individuals with tension-type, 8,48 posttraumatic, 29,48 and cervicogenic headaches 8,23,29 also respond to occipital nerve block.…”

Section: Introductionmentioning

confidence: 99%

Randomized, double-blind, comparative-effectiveness study comparing pulsed radiofrequency to steroid injections for occipital neuralgia or migraine with occipital nerve tenderness

Cohen

Peterlin

Fulton

et al. 2015

Pain

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Occipital neuralgia (ON) is characterized by lancinating pain and tenderness overlying the occipital nerves. Both steroid injections and pulsed radiofrequency (PRF) are used to treat ON, but few clinical trials have evaluated efficacy, and no study has compared treatments. We performed a multicenter, randomized, double-blind, comparative-effectiveness study in 81 participants with ON or migraine with occipital nerve tenderness whose aim was to determine which treatment is superior. Forty-two participants were randomized to receive local anesthetic and saline, and three 120 second cycles of PRF per targeted nerve, and 39 were randomized to receive local anesthetic mixed with deposteroid and 3 rounds of sham PRF. Patients, treating physicians, and evaluators were blinded to interventions. The PRF group experienced a greater reduction in the primary outcome measure, average occipital pain at 6 weeks (mean change from baseline −2.743 ± 2.487 vs −1.377 ± 1.970; P <0.001), than the steroid group, which persisted through the 6-month follow-up. Comparable benefits favoring PRF were obtained for worst occipital pain through 3 months (mean change from baseline−1.925 ± 3.204 vs−0.541 ± 2.644; P = 0.043), and average overall headache pain through 6 weeks (mean change from baseline −2.738 ± 2.753 vs −1.120 ± 2.1; P = 0.037). Adverse events were similar between groups, and few significant differences were noted for nonpain outcomes. We conclude that although PRF can provide greater pain relief for ON and migraine with occipital nerve tenderness than steroid injections, the superior analgesia may not be accompanied by comparable improvement on other outcome measures.

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Section: Introductionmentioning

confidence: 99%

Randomized, double-blind, comparative-effectiveness study comparing pulsed radiofrequency to steroid injections for occipital neuralgia or migraine with occipital nerve tenderness

Cohen

Peterlin

Fulton

et al. 2015

Pain

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“…Similarly, afferent nerve blockade such as anaesthesia of the greater occipital nerve has been proposed to reduce nociceptive input and hence headache and has been used with equivocal success in primary headaches [47, 48] but is recently used as a therapeutic option in refractory headache [49], cluster headache [50] and chronic migraine [51]. This concept is supported by clinical experiences and therapeutic efforts in tension-type headache and other primary headaches, which aim at decreasing muscle tension and nociceptive input from pericranial muscles [52, 53].…”

Section: Discussionmentioning

confidence: 99%

ATP-sensitive muscle afferents activate spinal trigeminal neurons with meningeal afferent input in rat – pathophysiological implications for tension-type headache

et al. 2016

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BackgroundTension-type headache and other primary headaches may be triggered or aggravated by disorders of pericranial muscles, which is possibly due to convergent or collateral afferent input from meningeal and muscular receptive areas. In rodent models high extracellular concentrations of ATP caused muscle nociception and central sensitization of second order neurons. In a rat model of meningeal nociception we asked if spinal trigeminal activity induced by ATP can be modulated by local anaesthesia of distinct muscles.MethodsOngoing activity was recorded from spinal trigeminal neurons with afferent input from the cranial dura mater, the temporal muscle and neck muscles. The stable ATP analogue α,β-methylene adenosine 5′-triphosphate (α,β-meATP, 10 mM) was injected into the ipsilateral temporal muscle, 30 min later followed by injection of local anaesthetics (lidocaine, 2 %) into the ipsilateral neck muscles and/or the temporal muscle.ResultsInjection of α,β-meATP into the temporal muscle caused progressive increase in ongoing activity of most of the spinal trigeminal neurons within 30 min. Injection of lidocaine into the neck muscles and/or the temporal muscle reduced this activation to previous levels within 10 min.ConclusionsDistinct spinal trigeminal neurons processing meningeal nociceptive information are under the control of convergent afferent input from several pericranial muscles. Blockade of at least one of these inputs can normalize central trigeminal activity. This may explain why therapeutic manipulations of head muscles can be beneficial in primary headaches.

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“…90 As in the previous study, response time was brisk for the corticosteroid group. A more recent open-label study 91 showed that the duration of response was 3 weeks.…”

Section: Occipital Nerve Blocksmentioning

confidence: 99%

Cluster Headache

Freitag

Florczak

2015

Headache and Migraine Biology and Management

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Greater occipital nerve blocks in chronic cluster headache: a prospective open‐label study

Abstract: GONB seems to be an efficacious treatment with reproducible effects in CCH patients. Performed three monthly, GONB may have a useful role in the management of CCH.

Cited by 87 publications

References 11 publications

Randomized, double-blind, comparative-effectiveness study comparing pulsed radiofrequency to steroid injections for occipital neuralgia or migraine with occipital nerve tenderness

Randomized, double-blind, comparative-effectiveness study comparing pulsed radiofrequency to steroid injections for occipital neuralgia or migraine with occipital nerve tenderness

ATP-sensitive muscle afferents activate spinal trigeminal neurons with meningeal afferent input in rat – pathophysiological implications for tension-type headache

Cluster Headache

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