The Effects of Greater Occipital Nerve Block and Trigger Point Injection on Brush Allodynia and Pain in Migraine

Abstract

Objective.—To evaluate the effect of GONB, with or without trigger point injection (TPI), on dynamic mechanical (brush) allodynia (BA) and on head pain in migraine. Background.—Patients with migraine often have cutaneous allodynia that is related to sensitization of central pain neurons. Greater occipital nerve block (GONB) is an effective treatment for migraine headache; however, its effect on cutaneous allodynia in migraine is unknown. Methods.—We studied patients with migraine and BA who were treated with GONB with or without TPI. Demographic data, migraine history, and headache features were documented. Allodynia was evaluated using a structured questionnaire and by applying a 4 × 4‐inch gauze pad to skin areas in the trigeminal and cervical dermatomes. Degree of allodynia (the allodynia score) was measured on a 100‐mm visual analog scale (VAS) before treatment and 10 and 20 minutes thereafter. Headache levels were assessed using an 11‐point verbal scale. Allodynia scores, as well as headache levels, before and after treatment were compared. Results.—Nineteen patients were studied. Mean age was 43.6 ± 11.8 years. Twenty minutes after treatment, headache was reduced in 17 patients (89.5%) and did not change in 2 (10.5%). The average headache level was 6.53 before treatment and 3.47, 20 minutes after it. The average allodynia score decreased after 20 minutes in all patients. Average allodynia score per site was reduced by 18.69 mm and 13.74 mm in the trigeminal and cervical areas, respectively. There was a positive correlation between allodynia index, obtained through the questionnaire, and allodynia score, obtained by examination. Conclusion.—GONB, with or without TPI, reduced both head pain and brush allodynia in this migraine patient group.

Greater Occipital Nerve Block for Acute Treatment of Migraine Headache: A Large Retrospective Cohort Study

“…Overall, our findings are very positive in terms of the efficacy of GON block as a treatment option for migraine headache. Our figures for response reflect closely some of the studies mentioned earlier, including Caputi and Firetto, 12 who described headache improvement in 85% of their cohort, and Ashkenazi and Young, 10 who documented decrease in head pain in 90% of their patients after GON block. Both of these studies had much smaller sample sizes: 27 and 19 patients, respectively.…”

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

“…Combined lidocaine blockade of GON and supraorbital (SO) nerves in 14 patients produced only negligible pain reduction (6%) after 30 minutes; 50% of patients did not respond at all (63). By contrast, in an open study of 25 patients with unilateral migraine (11 episodic and 14 chronic) and brush allodynia, a GON block with 1 cc of a 50/50 mixture of 2% lidocaine and 0.5% bupivacaine reduced headache intensity by a mean of 46.8% in 89.5% of patients after 20 minutes and ipsilateral allodynia by a mean of 65.7% in all patients (64). The same procedure reduced the pain and allodynia scores respectively by 64% and 75% after five minutes (65).…”

Nerve Blocks in the Treatment of Headache

“…In a study of 19 patients with acute migraine and allodynia, headache was relieved in 17, and allodynia was decreased in all patients. 11 Another study of 25 migraine patients found that 60% of subjects had significant improvement of migraine pain within 5 minutes of injection.…”