Greater Occipital Nerve Block with Local Anesthetics and Corticosteroids in Treatment-Resistant Chronic Migraine
Views: 824DOI:
https://doi.org/10.48208/HeadacheMed.2021.30Keywords:
Peripheral nerve block, Headache, Pain, Preventive treatmentAbstract
Objective: We investigated the efficacy and tolerability of greater occipital nerve block with lidocaine plus betamethasone in adults with chronic migraine in whom two or more previous preventive treatments were unsuccessful.
Methods: Ten participants were enrolled in a 24-weeks, randomized, double-blind, placebo-controlled, crossover trial conducted at a single tertiary headache center in Copenhagen (Denmark). After a 4-week run-in period, participants underwent treatment with bilateral greater occipital nerve block with lidocaine plus betamethasone (GONb) or lidocaine plus saline (placebo) with a 4-week interval wash-out phase between the 8-week crossover periods. The primary aim was to compare the number of migraine days during crossover periods after GONb or placebo. This trial is registered at ClinicalTrials.gov (NCT02686983).
Results: This study was stopped before achieving the a priori sample size, due to a slow enrollment. Ten participants were recruited, completed the study and were included in the analyses. At the baseline, the mean number of monthly migraine days was 22.9 (range, 14-30). No difference between GONb and placebo on the reduction of monthly migraine days was observed (p = 0.147; 95% CI between 0.6 and 3.7 days). Adverse events were recorded in two patients after GONb, compared with three patients after placebo.
Conclusions: GONb is not beneficial in patients with difficult-to-treat chronic migraine.
Downloads
References
The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia 2013;33(9):629-808 Doi:10.1177/0333102413485658 DOI: https://doi.org/10.1177/0333102413485658
Lanteri-Minet M. Economic burden and costs of chronic migraine. Curr Pain Headache Rep 2014;18(1):385 Doi:10.1007/s11916-013-0385-0 DOI: https://doi.org/10.1007/s11916-013-0385-0
Hepp Z, Dodick DW, Varon SF, Gillard P, Hansen RN and Devine EB. Adherence to oral migraine-preventive medications among patients with chronic migraine. Cephalalgia 2015;35(6):478-488 Doi:10.1177/0333102414547138 DOI: https://doi.org/10.1177/0333102414547138
Hepp Z, Dodick DW, Varon SF, Chia J, Matthew N, Gillard P, . . . Devine EB. Persistence and switching patterns of oral migraine prophylactic medications among patients with chronic migraine: A retrospective claims analysis. Cephalalgia 2017;37(5):470-485 Doi:10.1177/0333102416678382 DOI: https://doi.org/10.1177/0333102416678382
Ashkenazi A, Blumenfeld A, Napchan U, Narouze S, Grosberg B, Nett R, . . . Lipton RB. Peripheral nerve blocks and trigger point injections in headache management - a systematic review and suggestions for future research. Headache 2010;50(6):943-952 Doi:10.1111/j.1526-4610.2010.01675.x DOI: https://doi.org/10.1111/j.1526-4610.2010.01675.x
Caputi CA and Firetto V. Therapeutic blockade of greater occipital and supraorbital nerves in migraine patients. Headache 1997;37(3):174-179 Doi:10.1046/j.1526-4610.1997.3703174.x DOI: https://doi.org/10.1046/j.1526-4610.1997.3703174.x
Afridi SK, Shields KG, Bhola R and Goadsby PJ. Greater occipital nerve injection in primary headache syndromes--prolonged effects from a single injection. Pain 2006;122(1-2):126-129 Doi:10.1016/j.pain.2006.01.016 DOI: https://doi.org/10.1016/j.pain.2006.01.016
Naja ZM, El-Rajab M, Al-Tannir MA, Ziade FM and Tawfik OM. Occipital nerve blockade for cervicogenic headache: a double-blind randomized controlled clinical trial. Pain Pract 2006;6(2):89-95 Doi:10.1111/j.1533-2500.2006.00068.x DOI: https://doi.org/10.1111/j.1533-2500.2006.00068.x
Busch V, Jakob W, Juergens T, Schulte-Mattler W, Kaube H and May A. Functional connectivity between trigeminal and occipital nerves revealed by occipital nerve blockade and nociceptive blink reflexes. Cephalalgia 2006;26(1):50-55 Doi:10.1111/j.1468-2982.2005.00992.x DOI: https://doi.org/10.1111/j.1468-2982.2005.00992.x
Piovesan EJ, Kowacs PA, Tatsui CE, Lange MC, Ribas LC and Werneck LC. Referred pain after painful stimulation of the greater occipital nerve in humans: evidence of convergence of cervical afferences on trigeminal nuclei. Cephalalgia 2001;21(2):107-109 Doi:10.1046/j.1468-2982.2001.00166.x DOI: https://doi.org/10.1046/j.1468-2982.2001.00166.x
Inan LE, Inan N, Unal-Artık HA, Atac C and Babaoglu G. Greater occipital nerve block in migraine prophylaxis: Narrative review. Cephalalgia 2019;39(7):908-920 Doi:10.1177/0333102418821669 DOI: https://doi.org/10.1177/0333102418821669
Ashkenazi A, Matro R, Shaw JW, Abbas MA and Silberstein SD. Greater occipital nerve block using local anaesthetics alone or with triamcinolone for transformed migraine: a randomised comparative study. J Neurol Neurosurg Psychiatry 2008;79(4):415-417 Doi:10.1136/jnnp.2007.124420 DOI: https://doi.org/10.1136/jnnp.2007.124420
Dilli E, Halker R, Vargas B, Hentz J, Radam T, Rogers R and Dodick D. Occipital nerve block for the short-term preventive treatment of migraine: A randomized, double-blinded, placebo-controlled study. Cephalalgia 2015;35(11):959-968 Doi:10.1177/0333102414561872 DOI: https://doi.org/10.1177/0333102414561872
Kashipazha D, Nakhostin-Mortazavi A, Mohammadianinejad SE, Bahadoram M, Zandifar S and Tarahomi S. Preventive effect of greater occipital nerve block on severity and frequency of migraine headache. Glob J Health Sci 2014;6(6):209-213 Doi:10.5539/gjhs.v6n6p209 DOI: https://doi.org/10.5539/gjhs.v6n6p209
Martelletti P, Giamberardino MA and Mitsikostas DD. Greater occipital nerve as target for refractory chronic headaches: from corticosteroid block to invasive neurostimulation and back. Expert Rev Neurother 2016;16(8):865-866 Doi:10.1586/14737175.2016.1164599 DOI: https://doi.org/10.1586/14737175.2016.1164599
Shauly O, Gould DJ, Sahai-Srivastava S and Patel KM. Greater Occipital Nerve Block for the Treatment of Chronic Migraine Headaches: A Systematic Review and Meta-Analysis. Plast Reconstr Surg 2019;144(4):943-952 Doi:10.1097/prs.0000000000006059 DOI: https://doi.org/10.1097/PRS.0000000000006059
Tassorelli C, Diener HC, Dodick DW, Silberstein SD, Lipton RB, Ashina M, . . . Wang SJ. Guidelines of the International Headache Society for controlled trials of preventive treatment of chronic migraine in adults. Cephalalgia 2018;38(5):815-832 Doi:10.1177/0333102418758283 DOI: https://doi.org/10.1177/0333102418758283
Published
How to Cite
Issue
Section
License
Copyright (c) 2021 Vlasta Vukovic Cvetkovic, Roberto De Icco, Thien Phu Do, Lanfranco Pellesi, Messoud Ashina, Jakob Møller Hansen
This work is licensed under a Creative Commons Attribution 4.0 International License.
