Repeated greater occipital nerve injections with corticosteroids in medically intractable chronic cluster headache: a retrospective study

Brandt, Roemer B; Doesborg, Patty G. G.; Meilof, Roy; Coo, Ilse F. de; Bartels, Eveline C.; Ferrari, Michel D.; Fronczek, Rolf

doi:10.1007/s10072-021-05399-5

Cited by 7 publications

(5 citation statements)

References 16 publications

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“…Having this in mind, in the represented clinics of this paper, injections in 3 months intervals are considered safe. Repeated nerve blocks in medically refractory people with CCH led to transient attack freedom in only one third [ 75 ]. GON blocks are generally accepted for usage in pregnant and breastfeeding women [ 45 ].…”

Section: Introductionmentioning

confidence: 99%

Current treatment options for cluster headache: limitations and the unmet need for better and specific treatments—a consensus article

Lund,

Petersen,

Fronczek

et al. 2023

J Headache Pain

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Aim Treatment for cluster headache is currently based on a trial-and-error approach. The available preventive treatment is unspecific and based on few and small studies not adhering to modern standards. Therefore, the authors collaborated to discuss acute and preventive treatment in cluster headache, addressing the unmet need of safe and tolerable preventive medication from the perspectives of people with cluster headache and society, headache specialist and cardiologist. Findings The impact of cluster headache on personal life is substantial. Mean annual direct and indirect costs of cluster headache are more than 11,000 Euros per patient. For acute treatment, the main problems are treatment response, availability, costs and, for triptans, contraindications and the maximum use allowed. Intermediate treatment with steroids and greater occipital nerve blocks are effective but cannot be used continuously. Preventive treatment is sparsely studied and overall limited by relatively low efficacy and side effects. Neurostimulation is a relevant option for treatment-refractory chronic patients. From a cardiologist’s perspective use of verapamil and triptans may be worrisome and regular follow-up is essential when using verapamil and lithium. Conclusion We find that there is a great and unmet need to pursue novel and targeted preventive modalities to suppress the horrific pain attacks for people with cluster headache. Graphical Abstract

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Section: Introductionmentioning

confidence: 99%

Current treatment options for cluster headache: limitations and the unmet need for better and specific treatments—a consensus article

Lund,

Petersen,

Fronczek

et al. 2023

J Headache Pain

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“…Although there is a body of evidence that underscores the efficacy of NBs in migraineurs and headache patients, this study is the first to correlate the duration of NB response with headache surgery outcomes. [33][34][35][36] Although it is unclear why the duration of response matters, our hypothesis is that it can differentiate a central from a peripheral nerve problem. If nerve itself is causative for pain, the NB will anesthetize this nerve and deactivate the pain trigger longer than the effect of the local anesthetic.…”

Section: Discussionmentioning

confidence: 96%

Relative Pain Reduction and Duration of Nerve Block Response Predict Outcomes in Headache Surgery- A prospective cohort study

Knoedler

Chartier

Casari

et al. 2023

Plastic &Amp; Reconstructive Surgery

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areful selection of headache surgery candidates is essential to optimizing surgical outcomes. [1][2][3][4] Current screening algorithms include pain drawings, clinical history and physical examination, ultrasound, Doppler imaging, and diagnostic nerve blocks. [5][6][7][8][9] Furthermore, some patients undergo radiographic imaging such as computed tomography. 10,11 Several screening algorithms in the past have relied on positive response to botulinum toxin type A injections. [12][13][14][15] Although a history of positive response to botulinum toxin type A should still be noted during patient screening, preoperative botulinum toxin type A injection requires Background: Experts agree that nerve block (NB) response is an important tool in headache surgery screening. However, the predictive value of NBs remains to be proven in a prospective fashion. Methods: Pre-NB and post-NB visual analogue pain scores (0 to 10) and duration of NB response were recorded prospectively. Surgical outcomes were recorded prospectively by calculating the Migraine Headache Index (MHI) preoperatively and postoperatively at 3 months, 12 months, and every year thereafter. Results:The study population included 115 patients. The chance of achieving MHI percentage improvement of 80% or higher was significantly higher in subjects who reported relative pain reduction of greater than 60% following NB versus less than or equal to 60% [63 of 92 (68.5%) versus 10 of 23 (43.5%); P = 0.03]. Patients were more likely to improve their MHI 50% or more with relative pain reduction of greater than 40% versus 40% or less [82 of 104 (78.8%) versus five of 11 (45.5%); P = 0.01]. In subjects with NB response of greater than 15 days, 10 of 13 patients (77.0%) experienced MHI improvement of 80% or greater. Notably, all of these patients (100%) reported MHI improvement of 50% or greater, with mean MHI improvement of 88%. Subjects with a NB response of 24 hours or more achieved significantly better outcomes than patients with a shorter response (72.7% ± 37.0% versus 46.1% ± 39.7%; P = 0.02). However, of 14 patients reporting NB response of less than 24 hours, four patients had MHI improvement of 80% or greater, and seven, of 50% or greater. Conclusions: Relative pain reduction and duration of NB response are predictors of MHI improvement after headache surgery. NBs are a valuable tool to identify patients who will benefit from surgery.

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“…Local anesthetic with or without glucocorticoid is commonly used as the injectate. The use of glucocorticoids can be specifically effective for certain types of headaches such as cluster headaches [69].…”

Section: Greater Occipital Nervementioning

confidence: 99%

Outpatient Management of Chronic Pain

Liongson¹,

Bhalodi²,

McCarthy³

et al. 2023

Updates in Anesthesia - The Operating Room and Beyond

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In this chapter, we provide an overview of the most current techniques in the evaluation, diagnosis, and treatment of pain in the outpatient setting. We performed a targeted literature review by searching for the terms such as “chronic pain” and “pain management.” Relevant articles were cited, and findings were described in the chapter text. Additionally, we supplemented our review with images from the Spine and Pain Associates’ offices at St. Luke’s University Health Network (SLUHN) in Bethlehem, PA, as well as medical illustrations by our authors. We begin the review with a description of pain—its definition, components, complexity, and classifications and then provide a stepwise outline of the pharmacologic approach beyond nonsteroidal anti-inflammatory drugs before delving into newer interventional pain management procedures. Subsequently, this chapter is not comprehensive as it does not provide extensive discussion on older, more established procedures such as epidural steroid injections as well as practices falling out of favor such as discograms and neurolysis. Instead, we focus on newer subacute to chronic nonmalignant pain interventions. Finally, we attempt to highlight future directions of the growing field. Overall, we provide an overview of the management of chronic by providing insights into updates to chronic pain management.

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Repeated greater occipital nerve injections with corticosteroids in medically intractable chronic cluster headache: a retrospective study

Cited by 7 publications

References 16 publications

Current treatment options for cluster headache: limitations and the unmet need for better and specific treatments—a consensus article

Current treatment options for cluster headache: limitations and the unmet need for better and specific treatments—a consensus article

Relative Pain Reduction and Duration of Nerve Block Response Predict Outcomes in Headache Surgery- A prospective cohort study

Outpatient Management of Chronic Pain

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