Occipital Nerve Block Rapidly Eliminates Allodynia far from the Site of Headache: A Case Report

Young, William B.; Mateos, V.; Ashkenazi, Avi

doi:10.1111/j.1468-2982.2004.00779.x

Cited by 17 publications

(18 citation statements)

References 8 publications

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“…This study served to correlate disruptions in the DNIC system to trigeminal nociceptive afferents, suggesting its role in the development of CM [6]. The concept of pain modulation by DNIC systems was also noted by Young et al [9], who reported the alleviation of cutaneous allodynia in a C2-T5 distribution after the application of GONB, suggesting its utility not only for CM [19••,20,21•], but also for pain outside the distribution of the trigeminocervical complex.…”

Section: Pathophysiologic Theories and Treatment Correlatesmentioning

confidence: 80%

“…Three proposed mechanisms include the role of glutamate and the N-methyld-aspartic acid (NMDA) receptor [4,5•], disruptions of diffuse noxious inhibitory control (DNIC) systems [6], and dysfunction of brainstem structures (eg, the periaqueductal gray [PAG] and dorsal rostral pons) [7]. The relevance of these proposed mechanisms is supported by the effectiveness of medications that act upon glutamate receptors (eg, memantine [5•] and topiramate [8••]); greater occipital nerve block (GONB), which is believed to activate DNICs [9]; and greater occipital nerve stimulation (GONS), which has been shown to activate the PAG and dorsal rostral pons in positron emission tomography (PET) studies [7,10••]. This article describes these pathophysiologic fi ndings in CM, as well as treatment correlates, alongside their evidence for utility in treating CDH.…”

Section: Introductionmentioning

confidence: 98%

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Chronic migraine: Current pathophysiologic concepts as targets for treatment

Vargas

2009

Current Science Inc

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Chronic daily headache (CDH) affects approximately 4% of the population and exerts a significant degree of disability on its sufferers. Chronic migraine (CM) is a subset of CDH that represents migraine without aura occurring on 15 or more days per month for at least 3 months. Although numerous risk factors are associated with the development of CM, the pathophysiology governing its genesis is largely unknown. The role of neurotransmitters, such as glutamate, as well as disruptions of antinociceptive systems and structures, are implicated in CM and are supported by the fact that treatments targeting these abnormalities are effective.

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Section: Pathophysiologic Theories and Treatment Correlatesmentioning

confidence: 80%

Section: Introductionmentioning

confidence: 98%

Chronic migraine: Current pathophysiologic concepts as targets for treatment

Vargas

2009

Current Science Inc

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“…Twenty minutes after injections, headache level was reduced in 90% of patients and brush allodynia was decreased in all patients. Young et al [19] looked at the effect of GON block on extra-cranial cutaneous allodynia. They performed a GON block and cervical paraspinal trigger point injections on a woman with migraine who exhibited cutaneous allodynia over multiple dermatomes.…”

Section: Effect Of Gon Block On Cutaneous Allodyniamentioning

confidence: 99%

“…Allodynia in migraine probably results from sensitization of second-order sensory neurons in the TNC [18]. In some studies, the effect of GON block on both head pain and cutaneous allodynia was examined [13,19,20]. Ashkenazi and Young [13] evaluated the effect of GON block and trigger point injections on headache and on dynamic mechanical (brush) allodynia in 19 migraine patients.…”

Section: Effect Of Gon Block On Cutaneous Allodyniamentioning

confidence: 99%

Greater occipital nerve block for migraine and other headaches: Is it useful?

Ashkenazi

Levin²

2007

Curr Pain Headache Rep

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Peripheral nerve blocks have long been used in headache treatment. The most widely used procedure for this purpose has been greater occipital nerve (GON) block. The rationale for using GON block in headache treatment comes from evidence for convergence of sensory input to trigeminal nucleus caudalis neurons from both cervical and trigeminal fibers. Although there is no standardized procedure for GON blockade, the nerve is usually infiltrated with a local anesthetic (lidocaine, bupivacaine, or both). A corticosteroid is sometimes added. Several studies suggested efficacy of GON block in the treatment of migraine, cluster headache, and chronic daily headache. However, few were controlled and blinded. Despite a favorable clinical experience, little evidence exists for the efficacy of GON block in migraine treatment. Controlled studies are needed to better assess the role of GON block in the treatment of migraine and other headaches.

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“…The effects in migraine appear to last less than 60 days 11 . The onset of the benefit occurs within 2 min of the onset of the anesthesia, and is accompanied by relief of trigeminal and extratrigeminal allodynia, and photophobia 12,13 …”

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confidence: 99%