Greater Occipital Nerve Block with Local Anesthetics and Corticosteroids in Treatment-Resistant Chronic Migraine

Authors

DOI:

https://doi.org/10.48208/HeadacheMed.2021.30

Keywords:

Peripheral nerve block, Headache, Pain, Preventive treatment

Abstract

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.

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Author Biographies

Vlasta Vukovic Cvetkovic, Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup

Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Copenhagen, Denmark.

Roberto De Icco, Headache Science Centre, IRCCS Mondino Foundation; Dept. of Brain and Behavioral Sciences, University of Pavia

Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy.
Dept. of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.

Thien Phu Do, Danish Headache Center

Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Copenhagen, Denmark.

Lanfranco Pellesi, Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup

Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Copenhagen, Denmark.

Messoud Ashina, Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup

Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Copenhagen, Denmark.

Jakob Møller Hansen, Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup; Danish Headache Knowledge Center, Rigshospitalet Glostrup, Valdemar Hansens Vej

Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Copenhagen, Denmark.
Danish Headache Knowledge Center, Rigshospitalet Glostrup, Valdemar Hansens Vej, Copenhagen, Denmark.

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Published

16/11/2021

How to Cite

1.
Cvetkovic VV, Icco RD, Do TP, Pellesi L, Ashina M, Hansen JM. Greater Occipital Nerve Block with Local Anesthetics and Corticosteroids in Treatment-Resistant Chronic Migraine. HM [Internet]. 2021 Nov. 16 [cited 2022 Jan. 25];12(3):160-7. Available from: https://headachemedicine.com.br/index.php/hm/article/view/448

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Review

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