Kronik Migrenli Hastalarda Büyük Oksipital Sinir Bloğunun Etkinliği

Year 2021, Volume: 11 Issue: 6, 799 - 803, 20.11.2021

Meltem Karacan Gölen , Dilek Yılmaz Okuyan

https://doi.org/10.16899/jcm.955017

Cited By: 1

Abstract

Amaç: Kronik migrende medikal tedaviden faydalanma oldukça düşük olup, hastalarda sıklıkla yoğun analjezik kullanımı olduğu bilinmektedir. Bu nedenle periferal sinir blokajı özellikle GON blokajı tedaviye dirençli kronik migren hastalarında kullanılmaya başlanmıştır. Bu çalışmada kliniğimizde medikal tedaviye dirençli kronik migren tanısı nedeniyle GON (Greater Occipital Nerve) blokajı uyguladığımız hastalarımızın 3 aylık takiplerinde başağrısı atak sıklığını, analjezik kullanımını, VAS (Vizuel Analog Skala) değerleri ve MİDAS (Migren Özürlülük Değerlendirilmesi Ölçeği) skorlarını değerlendirmeyi amaçladık.
Gereç ve Yöntem: Çalışmaya 120 kronik migren hastası dahil edildi. Hastaların GON blokajı öncesi ve sonrası 1. ve 3. ayda analjezik kullanımı, ağrılı gün sayısı, VAS ve MİDAS skorları değerlendirildi.
Bulgular: GON blokajı uygulanan hastalarda ağrılı gün sayısı, analjezik kullanımı, VAS ve MİDAS skorlarında tedavi öncesi değerlerine göre 1.ve 3. ayda istatiksel olarak anlamlı (p<0,001*) azalma gözlenirken, 1. ve 3. ay bulguları arasında istatiksel olarak anlamlı fark gözlenmedi.
Sonuç: Çalışmamızda medikal tedaviye rağmen günlük yaşam aktivitelerini engelleyen şiddetli baş ağrıları olan hastalarda blokaj uygulanması sonrası baş ağrısında belirgin azalma ve hayat kalitesinde iyileşme dikkati çekmiştir. Tüm çalışmalarda etkin olduğu gösterilmiş, oldukça yüksek faydalanımı olan GON blokajının, migren hastalığı kronikleşmeden ,hastalar fazla medikal yüke maruz kalmadan ve tedavi maliyetleri artmadan tedavi seçeneği haline gelmesi düşünülebilir. 

Keywords

Baş ağrısı, kronik migren, büyük oksipital sinir blokajı

The Efficacy of Greater Occipital Nerve Block in Patients With Chronic Migraine

Abstract

Aim : In chronic migraines(CM), the rate of benefiting from medical treatment is relatively low, and it is known that patients use analgesics extensively. Greater occipital nerve (GON) block, have been started to be used in chronic migraine patients who were refractory to treatment. In this study, we aimed to evaluate the headache attack frequency, analgesic use, VAS (Visual Analog Scale) and MIDAS (Migraine Disability Assessment Scale) scores in the 3-month follow-up of patients we had performed a GON block in our clinic for chronic migraine refractory to medical treatment.
Materials and Methods: A total of 120 CM patients were included in the study. The number of analgesics used, the number of days with pain, and the VAS and MIDAS scores were recorded before the GON block and at one and three months of treatment.
Results: There was a statistically significant (p<0.001*) reduction in the number of days with pain, analgesic use, and the VAS and MIDAS scores in the first and third months compared to the pre-treatment baseline values in patients who had undergone a GON block. No significant differences between the first and third months.
Conclusion: After the GON block, we noted a significant reduction of headaches and improved quality of life in patients who had been experiencing severe headaches despite medical treatment. The GON block has an exceptionally high benefit rate, might be considered as a treatment option before migraines gain chronicity, patients are not exposed to an excessive medical burden and increased treatment costs.

Keywords

Headache, Chronic Migraine, Greater Occipital Nerve Block

References

• Referans1. [Anonym]. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia 2018; 38: 1-211. doi:10.1177/0333102417738202
• Referans 2. Lipton RB, Silberstein SD. Episodic and chronic migraine headache: breaking down barriers to optimal treatment and prevention. Headache 2015; 55 Suppl 2: 103-122; quiz 123-106. doi:10.1111/head.12505_2
• Referans 3. Baykan B, Ertas M, Karli N et al. Migraine incidence in 5 years: a population-based prospective longitudinal study in Turkey. J Headache Pain 2015; 16: 103. doi:10.1186/s10194-015-0589-2
• Referans 4. Caputi CA, Firetto V. Therapeutic blockade of greater occipital and supraorbital nerves in migraine patients. Headache 1997; 37: 174-179. doi:10.1046/j.1526-4610.1997.3703174.x
• Referans 5. Inan LE, Inan N, Unal-Artik HA et al. Greater occipital nerve block in migraine prophylaxis: Narrative review. Cephalalgia 2019; 39: 908-920. doi:10.1177/0333102418821669
• Referans 6. Kerr FW, Olafson RA. Trigeminal and cervical volleys. Convergence on single units in the spinal gray at C-1 and C-2. Arch Neurol 1961; 5: 171-178. doi:10.1001/archneur.1961.00450140053005
• Referans 7. Bartsch T, Goadsby PJ. Stimulation of the greater occipital nerve induces increased central excitability of dural afferent input. Brain 2002; 125: 1496-1509. doi:10.1093/brain/awf166
• Referans 8. Ashkenazi A, Young WB. The effects of greater occipital nerve block and trigger point injection on brush allodynia and pain in migraine. Headache 2005; 45: 350-354. doi:10.1111/j.1526-4610.2005.05073.x
• Referans 9. Afridi SK, Shields KG, Bhola R et al. Greater occipital nerve injection in primary headache syndromes--prolonged effects from a single injection. Pain 2006; 122: 126-129. doi:10.1016/j.pain.2006.01.016
• Referans 10.Blumenfeld A, Ashkenazi A, Napchan U et al. Expert consensus recommendations for the performance of peripheral nerve blocks for headaches--a narrative review. Headache 2013; 53: 437-446. doi:10.1111/head.12053
• Referans 11.Saracco MG, Valfre W, Cavallini M et al. Greater occipital nerve block in chronic migraine. Neurol Sci 2010; 31 Suppl 1: S179-180. doi:10.1007/s10072-010-0320-7
• Referans 12.Ashkenazi A, Matro R, Shaw JW et al. Greater occipital nerve block using local anaesthetics alone or with triamcinolone for transformed migraine: a randomised comparative study. J Neurol Neurosurg Psychiatry 2008; 79: 415-417. doi:10.1136/jnnp.2007.124420
• Referans 13. Ambrosini A, Vandenheede M, Rossi P et al. Suboccipital injection with a mixture of rapid- and long-acting steroids in cluster headache: a double-blind placebo-controlled study. Pain 2005; 118: 92-96. doi:10.1016/j.pain.2005.07.015
• Referans 14. Tetzlaff JE. The pharmacology of local anesthetics. Anesthesiol Clin North Am 2000; 18: 217-233, v. doi:10.1016/s0889-8537(05)70161-9
• Referans 15. Gul HL, Ozon AO, Karadas O et al. The efficacy of greater occipital nerve blockade in chronic migraine: A placebo-controlled study. Acta Neurol Scand 2017; 136: 138-144. doi:10.1111/ane.12716
• Referans 16. Dilli E, Halker R, Vargas B et al. Occipital nerve block for the short-term preventive treatment of migraine: A randomized, double-blinded, placebo-controlled study. Cephalalgia 2015; 35: 959-968. doi:10.1177/0333102414561872
• Referans 17. Kashipazha D, Nakhostin-Mortazavi A, Mohammadianinejad SE et al. Preventive effect of greater occipital nerve block on severity and frequency of migraine headache. Glob J Health Sci 2014; 6: 209-213. doi:10.5539/gjhs.v6n6p209
• Referans 18. Unal-Artik HA, Inan LE, Atac-Ucar C et al. Do bilateral and unilateral greater occipital nerve block effectiveness differ in chronic migraine patients? Neurol Sci 2017; 38: 949-954. doi:10.1007/s10072-017-2861-5
• Referans 19. Takmaz SA, Inan N, Ucler S et al. Greater occipital nevre block in migraine headache: Preliminary results of 10 patients. Ağrı 2008; 20: 47-50
• Referans 20. Okmen K, Dagistan Y, Dagistan E et al. Efficacy of the greater occipital nerve block in recurrent migraine type headaches. Neurol Neurochir Pol 2016; 50: 151-154. doi:10.1016/j.pjnns.2016.01.015
• Referans 21. Ruiz Piñero M, Mulero Carrillo P, Pedraza Hueso MI et al. Pericranial nerve blockade as a preventive treatment for migraine: Experience in 60 patients. Neurologia (Barcelona, Spain) 2016; 31: 445-451. doi:10.1016/j.nrl.2014.10.001