Vestibüler Migren Tedavisinde Büyük Oksipital Sinir Blokajı: Yanlış Tanıdan Etkili Tedaviye

Öz

Vestibüler migren (VM), genellikle periferik vertigo olarak yanlış teşhis edilen, epizodik vertigo ve migren semptomları ile karakterize, engelliliğe neden olan bir hastalıktır. Bu olgu sunumunda, dirençli VM'si olan 25 yaşındaki bir kadın hastanın, büyük oksipital sinir (GON) blokajı ile başarılı bir şekilde tedavi edilmesi anlatılmaktadır. GON blokajı, hem baş ağrısı hem de vestibüler semptomlarda hızlı ve belirgin bir rahatlama sağlamış olup, maliyet etkin ve az kullanılan bir müdahale olarak potansiyelini vurgulamaktadır. Bu olgu, dirençli VM yönetiminde doğru tanının ve multimodal tedavi yaklaşımlarının önemini vurgulamaktadır.

Anahtar Kelimeler

• büyük oksipital sinir blokajı
• vertigo
• vestibüler migren

Greater Occipital Nerve Block in the Management of Vestibular Migraine: A Case of Misdiagnosis and Recovery

Öz

Vestibular migraine (VM) is a challenging condition characterized by episodic vertigo and migraine symptoms, often misdiagnosed as peripheral vertigo. This case report describes a 25-year-old female with refractory VM successfully treated with greater occipital nerve (GON) block. The GON block provided rapid and significant relief of both headache and vestibular symptoms, underscoring its potential as a cost-effective and underutilized intervention. This case emphasizes the importance of accurate diagnosis and multimodal treatment approaches in the management of refractory VM.

Anahtar Kelimeler

• greater occipital nerve block
• vertigo
• vestibular migraine

Kaynakça

1. 1. Smyth D, Britton Z, Murdin L, Arshad Q, Kaski D. Vestibular migraine treatment: a comprehensive practical review. Brain. 2022;145(11):3741-54.
2. 2. Chen JY, Guo ZQ, Wang J, Liu D, Tian E, Guo JQ, et al. Vestibular migraine or Meniere's disease: a diagnostic dilemma. J Neurol. 2023;270(4):1955-68.
3. 3. Byun YJ, Levy DA, Nguyen SA, Brennan E, Rizk HG. Treatment of Vestibular Migraine: A Systematic Review and Meta-analysis. Laryngoscope. 2021;131(1):186-94.
4. 4. Young AS, Nham B, Bradshaw AP, Calic Z, Pogson JM, D'Souza M, et al. Clinical, oculographic, and vestibular test characteristics of vestibular migraine. Cephalalgia. 2021;41(10):1039-52.
5. 5. Chowdhury D, Tomar A, Deorari V, Duggal A, Krishnan A, Koul A. Greater occipital nerve blockade for the preventive treatment of chronic migraine: A randomized double-blind placebo-controlled study. Cephalalgia. 2023;43(2): 10.1177/03331024221143541.
6. 6. Cetin G, Totuk O, Cetin OE, Demir S, Sahin S. Evaluation of the effectiveness of greater occipital nerve blockade in menstrual migraine. BMC Neurol. 2025;25(1):62.
7. 7. Chang YJ, Hung KC, Chen IW, Kuo CL, Teng IC, Lin MC, et al. Efficacy of greater occipital nerve block for pain relief in patients with postdural puncture headache: A meta-analysis. Medicine (Baltimore). 2021;100(51):e28438.
8. 8. Chowdhury D, Datta D, Mundra A. Role of Greater Occipital Nerve Block in Headache Disorders: A Narrative Review. Neurol India. 2021;69(Supplement):S228-S56.

9. 9. Lempert T, Olesen J, Furman J, Waterston J, Seemungal B, Carey J, et al. Vestibular migraine: diagnostic criteria. J Vestib Res. 2012;22(4):167-72.
10. 10. Hoffmann J, Mehnert J, Koo EM, May A. Greater occipital nerve block modulates nociceptive signals within the trigeminocervical complex. J Neurol Neurosurg Psychiatry. 2021;92(12):1335-40.
11. 11. Dieterich M, Brandt T. The bilateral central vestibular system: its pathways, functions, and disorders. Annals of the New York Academy of Sciences. 2015;1343(1):10-26.
12. 12. Ak AK, Sarıtas AS, Gemici YI, Çağ EC, Çelebisoy N. A preliminary study evaluating the response to greater occipital nerve (GON) blockage therapy in patients with vestibular migraine. Neurology Asia. 2024;29(2):511-2.