The efficacy of ultrasound-guided multifidus cervicis plane block versus greater occipital nerve block for cervicogenic headache

Abstract

Introduction Traditionally, non-invasive and invasive techniques were used for the treatment of cervicogenic headache (CH). Greater occipital nerve block is the most frequent peripheral nerve block invasive technique used for the management of cervicogenic headache. The purpose of this prospective, double-blinded study was to compare the efficacy of two different techniques: multifidus cervicis plane block and greater occipital nerve block in the treatment of refractory cervicogenic headache by using ultrasound. Methods Sixty patients with cervicogenic headache were recruited and diagnosed according to the ICHD-III beta version. The patients were divided into two groups, one group was for greater occipital nerve block and the other group was for multifidus cervicis plane block with ultrasound-guided. Results Visual analog scale (VAS) was 2.09% in the multifidus cervicis plane block (MCPB) group and was 2.22% in the greater occipital nerve block (GONB) group with a median reduction of − 4.33 and − 3.048, respectively, at 2-week visits with a statistically significant difference better in the MCPB group (P < 0.001). At 4 weeks visits, VAS scale was better in the MCPB group than in the GONB group (3.79 and 4.44, respectively) with a median reduction in VAS scale (− 3.27 and − 3.095, respectively) and statistically significant differences between both groups (P = 0.020). Conclusion Both the ultrasound-guided multifidus cervicis plane block and greater occipital nerve block are effective as intervention techniques in the treatment of refractory cervicogenic headache. These techniques are simple, safe, more reliable with less side effects, and often reduce the requirements of analgesic drugs.

Nonsurgical Treatment of Neuralgia and Cervicogenic Headache: A Systematic Review and Meta-analysis

“… 19 , 24 In total, 196 out of 269 (73%) patients with headaches from the occipital region reported good results after injection with local anesthetics. The reported time of headache relief varied; Bovim and Sand 16 and Mohamed et al 21 reported a mean headache-free period of 30 minutes, and Martínez-Pías et al 20 found a mean headache-free period of 3.5 months. Among the studies that included patients with headache arising from the occipital region, an adverse event rate of 0%–9% was reported, including dizziness, blurring of vision, and hypertension.…”

“…Vincent et al 27 found a VAS improvement of 45.6% after a follow-up of 7 days (Table 2 ). 21 , 25 , 26…”

“…Both articles included patients with headache arising from the occipital region. Mohamed et al 21 treated 30 patients with a multifidus cervicis plane block and reported good results in 24 (80%) patients and a headache-free period of 30 minutes. Pan and Tan reported good results in 74% after treating patients with acupuncture plus acupoint-injection.…”

“…15 Two (7.7%) articles described other treatments including multifidus cervicis plane block and acupuncture followed by acupoint-injection with lidocaine (Table 1). 21,34…”

“…The majority of the studies evaluated the results of treatment with local anesthetics injection (62%). [14][15][16][17][18][19][20][21][22][23][24][25][26][27] Six (23%) articles described treatment with a combination of local anesthetics and corticosteroid, [28][29][30][31][32] three articles described treatment with oral analgesics, 14,17,33 two (7.7%) articles described treatment with botulinum toxin injection, 14,18 and one (3.8%) article described treatment with corticosteroid injection alone. 15 Two (7.7%) articles described other treatments including multifidus cervicis plane block and acupuncture followed by acupoint-injection with lidocaine (Table 1).…”