Occipital nerve block is effective in craniofacial neuralgias but not in idiopathic persistent facial pain

Abstract

Occipital nerve block (ONB) has been used in several primary headache syndromes with good results. Information on its effects in facial pain is sparse. In this chart review, the efficacy of ONB using lidocaine and dexamethasone was evaluated in 20 patients with craniofacial pain syndromes comprising 8 patients with trigeminal neuralgia, 6 with trigeminal neuropathic pain, 5 with persistent idiopathic facial pain and 1 with occipital neuralgia. Response was defined as an at least 50% reduction of original pain. Mean response rate was 55% with greatest efficacy in trigeminal (75%) and occipital neuralgia (100%) and less efficacy in trigeminal neuropathic pain (50%) and persistent idiopathic facial pain (20%). The effects lasted for an average of 27 days with sustained benefits for 69, 77 and 107 days in three patients. Side effects were reported in 50%, albeit transient and mild in nature. ONBs are effective in trigeminal pain involving the second and third branch and seem to be most effective in craniofacial neuralgias. They should be considered in facial pain before more invasive approaches, such as thermocoagulation or vascular decompression, are performed, given that side effects are mild and the procedure is minimally invasive.

Analgesic Effects of Preoperative Peripheral Nerve Block in Patients With Trigeminal Neuralgia Undergoing Radiofrequency Thermocoagulation of Gasserian Ganglion

“…9 Occipital nerve block using lidocaine and dexamethasone is useful in treating craniofacial neuralgias. 22 Betamethasone (Diprospan) is a potent glucocorticoid steroid with anti-inflammatory and immunosuppressive properties. In a model of lumbar radiculopathy, epidural injections of betamethasone attenuated thermal hyperalgesia.…”

Regional anesthesia in pain management

“…They have mostly shown efficacy in reducing pain intensity and/or frequency of pain attacks in different forms of headache. Most of the studies were prospective case series or audits, either using single injections or a series of procedures at variable intervals [27][28][29]. An observational study evaluated the effect of repeated GON and supraorbital nerve blocks on migraine patients, performed a maximum 10 times on alternate days: 85% of patients had a positive response during a 6-month observation period [30].…”

Long-term outcomes of intradural cervical dorsal root rhizotomy for refractory occipital neuralgia

“…16 However, nerve blocks provide only fleeting pain relief; one study noted that in 70% of its patients the pain recurred within 2 weeks and only 20% of the subjects had pain relief at 2.5 months after the block. 21 Many patients endure through multiple nerve blocks before seeking better options such as RFA, decompression of nerve roots, and neurostimulation.…”

“…16,32 The long-term efficacy of these procedures is unknown, making it difficult for patients and physicians to optimize refractory ON management. In this report, we describe our 14-year experience in a cohort of patients who underwent CDR for refractory ON.…”