Multiple cranial nerve blocks for the transitional treatment of chronic headaches

Miller, Sarah; Lagrata, Susie; Matharu, Manjit

doi:10.1177/0333102419848121

Cited by 29 publications

(26 citation statements)

References 22 publications

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“…Out of 124 headache patients who had MCNBs in the headache service within the study time period, patients without chronic migraine headache diagnoses were excluded, including those with episodic migraine, 9 cluster headache, 10 occipital neuralgia, 13 paroxysmal hemicranias, 6 cervicogenic headache, 6 and other cranial neuralgias 8 . Outcomes for 64 patients with a diagnosis of chronic migraine who underwent at least 1 MCNB procedure were collected.…”

Section: Resultsmentioning

confidence: 99%

“…There have been a few open label series, and more recently randomized control trials on the use of GON blocks in migraine, both with and without steroids 3‐7 . The use of corticosteroids in GON blocks is controversial but some experts argue in favor of it, as it may confer a prolonged antinociceptive effect 3‐4,8 . Unlike GON blocks, multiple cranial nerve blocks (MCNBs) include injecting superficial branches of the trigeminal nerve as well.…”

Section: Introductionmentioning

confidence: 99%

“…Consensus recommendations have recognized the paucity of clinical evidence for the use of MCNBs in migraine 9 . Previous randomized trials have found some promising results on the efficacy of nerve blocks in chronic migraine, and more recent real‐world data has shown that MCNBs are useful in the transitional treatment of chronic migraine 8 . We conducted a prospective cohort study with the aim of identifying the efficacy and safety of repetitive MCNBs in patients with chronic migraine who had not previously had nerve blocks for headache.…”

Section: Introductionmentioning

confidence: 99%

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Multiple Cranial Nerve Blocks as an Alternative Preventative Therapy for Chronic Migraine

et al. 2020

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Objective.-The objective of this prospective cohort study is to evaluate the efficacy of multiple cranial nerve blocks (MCNBs) as a preventative therapy for chronic migraine.Background.-MCNBs, namely greater occipital nerve (GON) blocks, are frequently used for the acute and transitional treatment of migraine. There is little evidence on the efficacy of repeated MCNBs as a preventative treatment for chronic migraine.Design.-This single-center, prospective cohort study collected demographic and outcome data on chronic migraine patients who had MCNBs in the headache service between June 2017 and March 2019. Outcome measures included reduction in headache days, Headache Impact Test 6 (HIT6) scores and patient-reported effectiveness of the blocks. Results.-Outcomes for 64 patients with a diagnosis of chronic migraine or chronic migraine with aura (MWA) were collected. Average age at first block procedure was 41 years (range 21-72) with a female predominance of 54/64 patients (84%). About 37/64 patients (58%) had repetitive occipital nerve blocks only, and 27/64 patients (42%) had occipital and trigeminal nerve blocks. Mean (±SD) reduction in headache days post-MCNBs was 5.4 (±5.0) days and mean (±SD) reduction in HIT6 scores was 5.3 (±10.3). About 42/64 patients (66%) responded to the MCNBs with at least a 30% reduction in headache days. Mean (±SD) duration of effect was 5.7 (±5.4) weeks. About 13/64 of the patients transformed to low-frequency episodic migraine on follow-up. About 22/64 patients (34%) showed no reduction in headache days or HIT6 scores. About 9/112 (8%) instances of minor post block complications were documented with a total of 501 injections. Conclusion.-This study demonstrates that repetitive MCNBs could provide effective prevention in patients with chronic migraine.Abbreviations: GON greater occipital nerve, HIT6 Headache Impact Test 6, MCNBs multiple cranial nerve blocks, MOH medication overuse headache (Headache 2020;60:981-987) Headache

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Multiple Cranial Nerve Blocks as an Alternative Preventative Therapy for Chronic Migraine

et al. 2020

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“…In another study, nine patients with palpation tenderness over the greater occipital nerve, superior orbital nerve, or trochlear area were treated with one or more blockades to the tender areas, and complete pain relief was found in five patients and partial relief in four patients. Finally, a larger series including six HC patients, who all had failed GONB, found a good response to MCNB in five patients [57]. Pooled analyses of two studies [23,26] with a total of 30 participants showed a responder proportion on GONB of 0.23 (95% CI 0.09 to 0.41), while pooled analyses of two studies [23,28] with a total of 13 participants showed a responder proportion on SONB of 0.83 (95% CI 0.55 to 1.00).…”

Section: Nerve Blockadesmentioning

confidence: 87%

Treatment of SUNCT/SUNA, Paroxysmal Hemicrania, and Hemicrania Continua: An Update Including Single-Arm Meta-analyses

Stubberud

Tronvik

Matharu

2020

Curr Treat Options Neurol

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Purpose of Review This review presents a critical appraisal of the treatment strategies for short-lasting unilateral neuralgiform headache attacks (SUNHA), paroxysmal hemicrania (PH), and hemicrania continua (HC). We assess the available, though sparse, evidence on both medical and surgical treatments. In addition, we present estimated pooled analyses of the most common treatments and emphasize recent promising findings. Recent Findings The majority of literature available on the treatment of these rare trigeminal autonomic cephalalgias are small open-label observational studies and case reports. Pooled analyses reveal that lamotrigine for SUNHA and indomethacin for PH and HC are the preventative treatments of choice. Second-line choices include topiramate, gabapentin, and carbamazepine for SUNHA; verapamil for PH; and cyclooxygenase-2 inhibitors and gabapentin for HC. Parenteral lidocaine is highly effective as a transitional treatment for SUNHA. Novel therapeutic strategies such as non-invasive neurostimulation, targeted nerve and ganglion blockades, and invasive neurostimulation, including implanted occipital nerve stimulators and deep brain stimulation, appears to be promising options. Summary At present, lamotrigine as a prophylactic and parenteral lidocaine as transitional treatment remain the therapies of choice for SUNHA. While, by definition, both PH and CH respond exquisitely to indomethacin, evidence for other prophylactics is less convincing. Evidence for the novel emerging therapies is limited, though promising.

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“…The long-term benefit and low rate of side effects, mostly mild and localized [66], make GON blocks a relevant option to be considered in the early treatment of cluster bouts [67]. There is limited evidence for the application of multiple cranial nerve injections [68] and a higher morbidity in comparison with a single injection.…”

Section: Local Corticosteroidsmentioning

confidence: 99%

Recent Advances in the Management of Cluster Headache

Villar-Martínez

Puledda

Goadsby

2020

Curr Treat Options Neurol

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Purpose of review Among the spectrum of pain conditions, cluster headache represents one of the most severe. Targeted therapies for cluster headache are evolving thus improving the available therapeutic armamentarium. A better understanding of the currently available therapies, as well as new and emerging options, may aide physicians to manage affected sufferers better by evolving treatment guidance. Recent findings While classic first-line medications are useful in some patients with cluster headache, they are often accompanied by significant side effects that limit their use. Recently, novel treatments with better tolerability and decreased medication interactions have proven to be effective. A remarkable example of this is the blockage of the calcitonin gene-related peptide pathway with monoclonal antibodies, which may be a key element in the future treatment of cluster headache. The sphenopalatine ganglion and vagus nerve perform a critical role in the regulation of pain and the trigeminal autonomic reflex. Neuromodulation therapies targeting these structures have shown excellent tolerability and few significant adverse events, constituting a promising form of treatment. Finally, several potential therapeutic targets are examined in this review, such as small molecule CGRP receptor antagonists, known as gepants, and serotonin receptor 5-HT1F receptor agonists: ditans. Summary In summary, a deepening of the understanding of cluster headache mechanisms in recent years has driven the evolution of sophisticated therapeutic approaches that could allow a new era in the treatment of this difficult condition.

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Multiple cranial nerve blocks for the transitional treatment of chronic headaches

Cited by 29 publications

References 22 publications

Multiple Cranial Nerve Blocks as an Alternative Preventative Therapy for Chronic Migraine

Multiple Cranial Nerve Blocks as an Alternative Preventative Therapy for Chronic Migraine

Treatment of SUNCT/SUNA, Paroxysmal Hemicrania, and Hemicrania Continua: An Update Including Single-Arm Meta-analyses

Recent Advances in the Management of Cluster Headache

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