Occipital Nerve Blocks: Effect of Symptomatic Medication

Abstract

Objective.-To explore the effect of symptomatic medication overuse (SMO) and headache type on occipital nerve block (ONB) efficacy.Methods.-We conducted a chart review of all of the ONBs performed in our clinic over a 2-year period.Results.-Of 108 ONBs with follow-up data, ONB failed in 22% of injections overall. Of the other 78%, the mean decrease in head pain was 83%, and the benefit lasted a mean of 6.6 weeks. Failure rate without SMO was 16% overall, and with SMO was 44% overall (P < .000). In those who did respond, overall magnitude and duration of response did not differ between those with and those without SMO. Without SMO, ONB failure rate was 0% for postconcussive syndrome, 14% for occipital neuralgia, 11% for non-intractable migraine, and 39% for intractable migraine. With SMO, failure rate increased by 24% (P = .14) in occipital neuralgia, by 36% (P = .08) for all migraine, and by 52% (P = .04) for non-intractable migraine.Conclusions.-SMO tripled the risk of ONB failure, possibly because medication overuse headache does not respond to ONB. SMO increased ONB failure rate more in migraineurs than in those with occipital neuralgia, possibly because migraineurs are particularly susceptible to medication overuse headache. This effect was much more pronounced in non-intractable migraineurs than in intractable migraineurs.

Efficacy and safety of 121 injections of the greater occipital nerve in episodic and chronic cluster headache

“…Nearly 80% of all infiltrations showed a complete or partial response. These findings are in accordance with previous studies (2,5,8).…”

Greater occipital nerve blockade for the treatment of chronic migraine: a randomized, multicenter, double-blind, and placebo-controlled study

“…The efficacy of GON blockade in the treatment of various types of headache has been assessed in a number of studies (9)(10)(11)(12)(13)(14)(15)(16)(17)(18). However, few of these studies were controlled studies.…”

Targeting pericranial nerve branches to treat migraine: Current approaches and perspectives

“…Medication overuse tripled the risk of failure of the treatment in one study (58) but had no influence on outcome in two other ones (55,59). In many studies palpation tenderness in the GON region was taken intuitively as a criterion for selecting patients for GON blockade/infiltration.…”

“…The major studies are summarized in Table 1 ( [51][52][53][54][55][56][57][58][59][60][61][62]. Unfortunately, there are very few controlled trials and no standardized methods were used for the selection of migraine patients (some had fixed unilateral headache, others not), the timing of infiltrations (ictal or interictal), the technique of infiltrations or blocks (unilateral or bilateral, association with blocks of other pericranial nerves or trigger point injections, one or more interventions), the compounds used for the blocks (local anesthetics alone or combined with different types and dosages of steroids) and particularly the evaluation of outcomes (number of headache-free days, variable percentage reduction of headache days or attacks, non-uniformly standardized pain indices).…”