Hiccup Following Bilateral Ultrasound-Guided Greater Occipital Nerve Block: A Rare Adverse Event

Öz

Greater occipital nerve (GON) block is widely used for treating primary and secondary headache disorders and is generally considered safe. Nevertheless, unexpected adverse effects may occasionally occur. We describe a 45-year-old man with migraine who developed persistent hiccups following bilateral ultrasound-guided GON block. The procedure was performed in the prone position using an in-plane approach to target the GON between the obliquus capitis inferior and semispinalis capitis muscles. A total of 4 mL of 0.5% bupivacaine with dexamethasone (4 mg per side) was injected. No immediate complications were noted, but continuous hiccups developed nine hours later. Clinical and laboratory evaluations excluded common etiologies such as reflux, metabolic disorders, and central nervous system pathology. Supportive measures were provided, and symptoms resolved spontaneously within 48 hours. To our knowledge, this is the first report of hiccups after GON block. Clinicians should be aware of this rare but distressing outcome.

Anahtar Kelimeler

• Case Report
• Greater Occipital Nerve Block
• Hiccup
• Migraine
• Ultrasound Guidance

Ultrasonografi Kılavuzluğunda Bilateral Büyük Oksipital Sinir Bloğu Sonrası Gelişen Hıçkırık: Nadir Bir Advers Etki

Öz

Büyük oksipital sinir (GON) bloğu, primer ve sekonder baş ağrılarının tedavisinde yaygın olarak kullanılan ve genellikle güvenli kabul edilen bir girişimdir. Bununla birlikte, nadir ve öngörülmeyen yan etkiler görülebilir. Bu olgu sunumunda, bilateral ultrason kılavuzluğunda GON bloğu sonrası inatçı hıçkırık gelişen 45 yaşında migrenli bir erkek hasta sunulmaktadır. İşlem pron pozisyonda, in-plane yaklaşım ile obliquus capitis inferior ve semispinalis capitis kasları arasındaki GON hedeflenerek gerçekleştirildi. Her iki tarafa 4 mg deksametazon içeren toplam 4 mL %0,5 bupivakain enjekte edildi. İşlem sonrası erken dönemde komplikasyon gözlenmedi; ancak yaklaşık dokuz saat sonra başlayan sürekli hıçkırık 48 saat boyunca devam etti. Klinik ve laboratuvar incelemeleri, gastroözofageal reflü, metabolik bozukluklar ve santral sinir sistemi patolojilerini dışladı. Destekleyici tedavi uygulanmasının ardından semptomlar spontan olarak geriledi. Bildiğimiz kadarıyla bu, GON bloğu sonrası bildirilen ilk inatçı hıçkırık olgusudur. Klinik uygulamalarda bu tür nadir yan etkilerin göz önünde bulundurulması önemlidir.

Anahtar Kelimeler

• Büyük oksipital sinir bloğu
• Hıçkırık
• Migren
• Olgu sunumu
• Ultrason kılavuzluğunda girişim
• Büyük oksipital sinir (GON) bloğu

Kaynakça

1. Leonardi M, Martelletti P, Burstein R, et al. The World Health Organization Intersectoral Global Action Plan on Epilepsy and Other Neurological Disorders and the headache revolution: from headache burden to a global action plan for headache disorders. J Headache Pain 2024;25(1):4.
2. Hasırcı Bayır BR, Gürsoy G, Sayman C, et al. Greater occipital nerve block is an effective treatment method for primary headaches? Ağrı 2022;34(1):47-53.
3. Zhang H, Yang X, Lin Y, et al. The efficacy of greater occipital nerve block for the treatment of migraine: a systematic review and meta-analysis. Clin Neurol Neurosurg 2018;165:129-133.
4. Chang FY, Lu CL. Hiccup: mystery, nature and treatment. J Neurogastroenterol Motil 2012;18(2):123-130.
5. Becker DE. Nausea, vomiting, and hiccups: a review of mechanisms and treatment. Anesth Prog 2010;57(4):150-156.
6. Abbasi A, Roque-Dang CM, Malhotra G. Persistent hiccups after interventional pain procedures: a case series and review. PM R 2012;4(2):144-151.
7. Friedman BW, Irizarry E, Williams A, et al. A randomized, double-dummy, emergency department-based study of greater occipital nerve block with bupivacaine vs intravenous metoclopramide for treatment of migraine. Headache 2020;60(10):2380-2388.
8. Sánchez MM, Young LJ, Plotsky PM, et al. Distribution of corticosteroid receptors in the rhesus brain: relative absence of glucocorticoid receptors in the hippocampal formation. J Neurosci 2000;20(12):4657-4668.

9. Inan LE, Inan N, Unal-Artık HA, Atac C, Babaoglu G. Greater occipital nerve block in migraine prophylaxis: narrative review. Cephalalgia 2019;39(7):908-920.
10. Thompson DF, Landry JP. Drug-induced hiccups. Ann Pharmacother 1997;31(3):367-369.
11. Hung YM, Miller MA, Patel MM. Persistent hiccups associated with intravenous corticosteroid therapy. J Clin Rheumatol 2003;9(5):306-309.
12. Gilbar P, McPherson I. Severe hiccups during chemotherapy: corticosteroids the likely culprit. J Oncol Pharm Pract 2009;15(4):233-236.
13. Ross J, Eledrisi M, Casner P. Persistent hiccups induced by dexamethasone. West J Med 1999;170(1):51-52.
14. Sugandhavesa N, Sawaddiruk P, Bunmaprasert T, Pattanakuhar S, Chattipakorn SC, Chattipakorn N. Persistent severe hiccups after dexamethasone intravenous administration. Am J Case Rep 2019;20:628-630.
15. Peacock ME. Transient hiccups associated with oral dexamethasone. Case Rep Dent 2013;2013:426178.
16. Ege F. Persistent hiccups as a rare complication after transforaminal epidural steroid injection: a case report. Ağrı 2024;36(4):266-268.
17. Habib G, Artul S, Hakim G. Annoying Hiccups following Intra-Articular Corticosteroid Injection of Betamethasone Acetate/Betamethasone Sodium Phosphate at the Knee Joint. Case Rep Rheumatol 2013;2013:829620.