Preventive Effect of Greater Occipital Nerve Block on Severity and Frequency of Migraine Headache

Kashipazha, Davood; Nakhostin-Mortazavi, Ali; Mohammadianinejad, Seyyed Ehsan; Bahadoram, Mohammad; Zandifar, Sepideh; Tarahomi, Shahram

doi:10.5539/gjhs.v6n6p209

Cited by 50 publications

(59 citation statements)

References 13 publications

(13 reference statements)

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“…Medication overuse was not associated with an increased risk of failure of GON blocks in two studies (16,17), but it tripled this risk in another study (18). The presence of GON palpation tenderness was associated with better outcome in one study (16), but not in two others (12,17). The effect of GON blocks on headache frequency and intensity does not predict the success of GON neurostimulation in chronic migraineurs (19).…”

Section: Migrainementioning

confidence: 95%

Invasive pericranial nerve interventions

Ambrosini

Schoenen

2016

Cephalalgia

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Background In many patients suffering from primary headaches, the available pharmacological and behavioural treatments are not satisfactory. This is a review of (minimally) invasive interventions targeting pericranial nerves that could be effective in refractory patients. Methods The interventions we will cover have in common pericranial nerves as targets, but are distinct according to their rationale, modality and invasiveness. They range from nerve blocks/infiltrations to the percutaneous implantation of neurostimulators and surgical decompression procedures. We have critically analysed the published data (PubMed) on their effectiveness and tolerability. Results and conclusions There is clear evidence for a preventative effect of suboccipital injections of local anaesthetics and/or steroids in cluster headache, while evidence for such an effect is weak in migraine. Percutaneous occipital nerve stimulation (ONS) provides significant long-term relief in more than half of drug-resistant chronic cluster headache patients, but no sham-controlled trial has tested this. The evidence that ONS has lasting beneficial effects in chronic migraine is at best equivocal. Suboccipital infiltrations are quasi-devoid of side effects, while ONS is endowed with numerous, though reversible, adverse events. Claims that surgical decompression of multiple pericranial nerves is effective in migraine are not substantiated by large, rigorous, randomized and sham-controlled trials.

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Section: Migrainementioning

confidence: 95%

Invasive pericranial nerve interventions

Ambrosini

Schoenen

2016

Cephalalgia

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“…In fact, there is some evidence that adding corticosteroids to LAs when blocking the GON for migraine is not associated with added benefit, compared with blocking the nerve with LAs alone. 11,14 The data for migraine differ from those for CH, which showed superior results of injecting corticosteroids with lidocaine to the GON area, compared with the injection of saline and lidocaine. 27 Performing ONB using corticosteroids only (eg, in patients who are allergic to LAs) may be effective.…”

Section: Expert Opinionmentioning

confidence: 97%

“…One month post treatment, 52% of patients had ≥50% decrease in headache days, compared with pretreatment. In a randomized, controlled, double‐blinded study, Kashipazha et al examined the effect of GONB on 48 migraine patients . Patients received GON injections using lidocaine + either triamcinolone or saline.…”

Section: Expert Opinionmentioning

confidence: 99%

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Occipital and Trigeminal Nerve Blocks for Migraine

2015

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To block or not to block, that is the question. CLINICAL HISTORIESCase 1.-This is a 53-year-old male seen for consultation due to headaches since high school, which have been almost daily for the past 20 years. He describes a throbbing pain behind the left eye, with an intensity of 5-9/10 and posterior cervical pressure, occasionally associated with nausea and vomiting, but no light or sound sensitivity. He takes rizatriptan 10 mg daily, and the headache is gone in about 1 hour. Every couple of weeks, the headache recurs and he takes another dose of rizatriptan. He takes hydrocodone 1-2 tablets every couple of weeks. Alcohol triggers his headaches. Sumatriptan injections and baclofen did not help. He has tried topiramate, amitriptyline, divalproex sodium, gabapentin, and propranolol for headache prevention, without help. He also tried onabotulinumtoxinA once, without help. Chiropractic treatment did not help. He has not tried acupuncture. Magnetic resonance imaging of the brain with and without contrast, done 3 months previously, was negative. He has a past medical history of hyperlipidemia, treated with a statin. Neurological examination was normal. There was bilateral greater occipital nerve (GON) tenderness. Bilateral greater occipital nerve block (GONB) was performed by injection of 3 mL of 1% lidocaine 2 cm lateral and 2 cm inferior to the inion on each side. For headache prevention, he was started on zonisamide 100 mg daily for 2 weeks and then 200 mg daily. He was informed on the risk of medication overuse headache with frequent use of rizatriptan. He was seen in follow-up 2 months later. During the 2 weeks after the occipital nerve blocks (ONBs), he had one headache that was quickly relieved by rizatriptan. For the following 14 days, he experienced headaches once every other day, and thereafter his daily headache pattern resumed, with prompt relief by rizatriptan.Case 2.-This is a 45-year-old woman with a 15-year history of migraine without aura occurring about 2-3 times per month. She takes eletriptan 40 mg tablets, with relief of the headache in 2 hours. She presents with a 2-day history of a typical right-sided throbbing headache of 9/10 intensity, associated with nausea, vomiting, as well as light and sound sensitivity. Her symptoms did not respond to 2 doses of eletriptan and promethazine suppository. A right GONB was performed by injection of 3 mL of 1% lidocaine 2 cm lateral and 2 cm inferior to the inion, with relief of the headache within 10 minutes. Subsequently, she has had 2 similar episodes that were quickly relieved by ONBs.Case 3.-This is a 58-year-old male seen in consultation with headaches since high school, which have been daily for the past month. Prior to that, he had approximately 4 headache days per week for many years. He describes a bilateral retro-orbital and temporal pain with nuchal-occipital throbbing and pres-

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“…Genellikle plesoba kontrollü çalışmalarda steroidlere lokal anestezik veya salin uygulamasının karşılaştırıldığında, lokal anestezik grubunda sonuç-ların daha etkili olduğu gösterilmiştir. [17] Takmaz ve arkadaşlarının çalışmasında toplam 1.5 ml %0.5 bupivakain uygulamışlar, bupivakain efektif, güvenli ve etkin olduğunu göstermişlerdir. [18] Dilli ve arkadaşları…”

Section: Kaynaklarunclassified

The Results of Greater Occipital Nerve Block Applied for Migraine Headache

Çatav¹,

Solmaz

Kirdemi̇r³

2017

Agri

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Sonuç: Migren başağrısında GON bloğu 1.5 ml %2 lidokain ile güvenilir, basit ve efektif bir tedavi yöntemidir.Anahtar sözcükler: Büyük oksipital sinir bloğu; lidokain; migren. SummaryObjectives: The aim of this study was to evaluate the efficacy of greater occipital nerve (GON) block in the treatment of migraine patients.Methods: This study included 28 patients diagnosed with migraine between 2014 and 2015. The GON block procedure was applied by administering 1.5 ml of 2% lidocaine 2 cm lateral and 2 cm inferior to the external occipital protuberance. The patients were evaluated in respect of VAS scores, attack frequency, attack duration and the need for analgesia before the procedure. These parameters were evaluated again at 1 week, 1 month and 3 months after the procedure. Results:The mean age of the patients was 42.21±10.13 years. The mean VAS score was 9.28±0.72 before the procedure and 2.96±2.16 at 1 week, 2.60±1.96 at 1 month and 1.75±1.37 at 3 months. The frequency of attacks was 9.42±4.51 before the procedure and, 5.42±3.30 at 1 month and 3.57±3.14 at 3 months.Conclusion: GON block with 1.5 ml of 2% lidocaine is a safe, simple and effective treatment method for migraine headache.Keywords: Greater occipital nerve block; lidocaine; migraine. Migren başağrısında büyük oksipital sinir bloğu uygulama sonuçlarımızThe results of greater occipital nerve block applied for migraine headache Serdar ÇATAV, Filiz ALKAYA SOLMAZ, Pakize KIRDEMIR

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Preventive Effect of Greater Occipital Nerve Block on Severity and Frequency of Migraine Headache

Cited by 50 publications

References 13 publications

Invasive pericranial nerve interventions

Invasive pericranial nerve interventions

Occipital and Trigeminal Nerve Blocks for Migraine

The Results of Greater Occipital Nerve Block Applied for Migraine Headache

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