Three men in a boat: The comparison of the combination therapy of botulinum toxin and greater occipital nerve block with bupivacaine, with botulinum toxin monotherapy in the management of chronic migraine

Migraine treatment with GON blockade at the level of C2: The tip of the iceberg and the submerged portion

“…In this mini-review, five trials involving GON blockade at the C2 level were summarized [10][11][12][13][14] . Although all patients had a diagnosis of migraine, one study also included medication overuse headache (MOH) 14 . In all of these studies, bupivacaine was preferred as the local anesthetic during GON blockade.…”

“…Although this side effect was also observed after distal blockade, its incidence was not that high 1 . Serious side effects were not observed in GON blockade administered at the C2 level with a total dose of 4 ml in studies [12][13][14] . However, in the study by Karaoğlan et al 12 in which undiluted bupivacaine was bilaterally administered a side effect defined as "cerebellar like syndrome" by the author and not previously reported in the literature, was observed and supported by video.…”

“…In all of the studies conducted by Karaoğlan et al, [12][13][14] the total solution dose of 4 ml was applied. However, there were differences in the doses used among these three studies.…”

“…However, there were differences in the doses used among these three studies. Notably, in Karaoğlan's last study 14 , although the total bupivacaine dose was kept constant at 4 ml, bupivacaine was diluted to 0.125 %.…”