Treatment of Post‐Dural Puncture Headache With Bilateral Greater Occipital Nerve Block

Takmaz, Suna Akın; Kantekin, Çiğdem Ünal; Kaymak, Çetin; Başar, Hülya

doi:10.1111/j.1526-4610.2010.01656.x

Cited by 28 publications

(20 citation statements)

References 16 publications

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“…It is a common cause of headaches, and, because of the close association of the nerve and artery, it can present with unilateral throbbing pain, associated with nausea, vomiting, and emesis, meeting the International Headache Society criteria for migraine headaches. GON injections have been used for cervicogenic, cluster‐type, and post‐dural puncture headaches …”

Section: Discussionmentioning

confidence: 99%

New Technique for Cryoneuroablation of the Proximal Greater Occipital Nerve

2019

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Study design Description of a new technique. Objectives To describe a safe ultrasound (US)‐guided cryoneuroablation technique of the proximal greater occipital nerve (GON). Background Cryoneuroablation is a treatment option for occipital neuralgia, providing more sustained relief when steroid injections fail. US can identify the proximal GON between the C2 spinous and C1 transverse process over the inferior oblique capitis muscle (IOCM), where the GON is clearly visualized. US‐guided GON injections are often performed with an out‐of‐plane approach; however, that approach is difficult with cryoneuroablation, because the probe has no opening (prohibiting hydrodissection), and the size and dullness of the probe hinders easy manipulation. Setting University‐based outpatient pain clinic. Methods We provide a description of the procedure based on experience in the authors’ clinic. With the patient in the prone position, the US probe is placed parallel to the IOCM. The GON is seen on top of the IOCM; a midline 2‐mm incision allows access to the bilateral GONs with a single skin entry. Using an in‐plane approach, the cryo probe is advanced to the nerve in a medial‐to‐lateral direction, with constant US visualization, staying far away from the spinal cord and vertebral artery, which increases safety. Conclusions Based on anecdotal evidence from the authors’ clinic, cryoneuroablation of the proximal GON can be performed safely at the level of the IOCM. Limitations The procedure described is based on anecdotal evidence from a small number of patients; however, the procedure is promising and formal study is warranted.

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Section: Discussionmentioning

confidence: 99%

New Technique for Cryoneuroablation of the Proximal Greater Occipital Nerve

2019

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“…1,2,11 Bilateral greater occipital nerve (BGON) block is an interesting alternative to epidural blood patch because it is easy to perform and, in expert hands, has a minimal risk of side effects. 3,5,8 The evoked risks related to greater occipital nerve block are haematoma, pain, vasovagal reaction, dizziness, infection, alopecia and cutaneous atrophy. [3][4][5]8,[12][13][14] The conditions that have been treated with BGON block are occipital neuralgia and cervicogenic headache.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Bilateral greater occipital nerve block (BGON) has been reported for the successful treatment of PDPH. [3][4][5] Authors suggest that treatment of PDPH with BGON block seems to be a minimally invasive, easy and effective method and may be considered before the application of a blood patch. 5 The analgesia obtained after the BGON block may be explained by the central neuromodulatory effect that causes decreased central sensitisation due to the temporary interruption of afferent input to the dorsal roots and trigeminal nucleus.…”

Section: Introductionmentioning

confidence: 99%

Bilateral greater occipital nerve block for headache after corrective spinal surgery: a case report

Neto¹,

Martínez

DeKoven

et al. 2018

Southern African Journal of Anaesthesia and Analgesia

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“…GON blockade is used in various type of headaches like migraine, occipital neuralgia, servicogenic headache, postdural puncture headache (PDPH) with generally favorable clinical outcomes. [19,20] For a long time, GON blockade has been performed by classical approach using anatomical landmarks (Figure 1). In one related study, 10 patients who received GON pulsed radiofrequency (PRF) by classical landmark technique due to occipital neuralgia were followed up for 7.5 months on average, and their pain scores decreased to 0.8 after PRF from 6.9.…”

Section: Musculoskeletal Interventions In Chronic Painmentioning

confidence: 99%

Ultrasound guided chronic pain interventions (Part I)

Akkaya

Alptekin

Özkan

2015

Agri

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SummaryRecently, ultrasonography (US) is an indispensible imaging technique in regional anesthesia practice. With the guidance of US, various invasive interventions in chronic pain pathologies of the musculoskeletal system, peripheral and neuroaxial pathologies has become possible. The management includes diagnostic blocks as weel as radiofrequency ablation and institution of neurolythic agents. During these algologic interventions we are able to see the target tissue, the dispersion of the drug and all nearby vascular structures. Besides these the US also protects the team from ionic radiation that one encounters when using flouroscopy or computed tomography. Latest publications in this field show that applicability of US in chronic pain syndromes is rapidly expanding with a good future. The additional equipment (echogenic needles, 3-D US etc.) will also expand its applications in algology practice. This review highlights different applications of US in chronic pain conditions. Keywords: Chronic pain; nerve blocks; ultrasound. ÖzetSon zamanlarda rejyonal anestezi pratiğinde ultrasonografi (US) vazgeçilmez görüntüleme tekniği olarak yerini almıştır. Ultrasonografi ile kas/iskelet, periferik ve nöraksial bölgelerin kronik ağrılı patolojilerde çeşitli invaziv girişimler yapmak olasıdır. Bu girişimler diagnostik bloklar, radyofrekans uygulamaları ve nörolitik ajanların uygulamaları olarak özetlenebilirler. Algolojik girişimler esnasında US; hedef dokuların görüntülenmesinde, uygulanan ilacın yayılımında, çevredeki vasküler yapıların görün-tülenmesinde büyük kolaylıklar sağlar. Ayrıca US ile floroskopi veya bilgisayarlı tomografi uygulamaları esnasındaki radyasyon yayılımı söz konusu değildir. Kronik ağrı girişimlerinde US ile yayınlanan klinik çalışmalar umut vericidir. Ayrıca son yıllarda bu alandaki gelişmeler (ekojen iğneler, üç boyutlu US cihazları vd.) US'nin algoloji pratiğindeki kullanımının daha da yaygınlaşaca-ğını düşündürmektedir. Bu derlemenin amacı, US eşliğinde yapılan çeşitli kronik ağrı girişimlerini gözden geçirmektir.

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Treatment of Post‐Dural Puncture Headache With Bilateral Greater Occipital Nerve Block

Cited by 28 publications

References 16 publications

New Technique for Cryoneuroablation of the Proximal Greater Occipital Nerve

New Technique for Cryoneuroablation of the Proximal Greater Occipital Nerve

Bilateral greater occipital nerve block for headache after corrective spinal surgery: a case report

Ultrasound guided chronic pain interventions (Part I)

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