Effectiveness of greater occipital nerve blocks in chronic migraine

Yıl 2021, Cilt: 5 Sayı: 6, 593 - 596, 01.06.2021

Esra Aciman Demirel , Burcu Karpuz , Sibel Özdemir Gülcan Kalaycı Hüseyin Tuğrul Atasoy

https://doi.org/10.28982/josam.911665

Öz

Background/Aim: Chronic migraine (CM) is defined as headache occurring on 15 or more days per month for more than three months, which, on at least 8 days per month, has the features of a migraine headache. Greater occipital nerve (GON) blocks with local anesthetics and steroids are used in CM. GON block is widely used effectively in CM treatment. The aim of this study was to assess the effectiveness of GON blocks in CM.
Methods: This retrospective cohort study was conducted in Bulent Ecevit University Faculty of Medicine, Department of Neurology. Data of 43 CM patients who had GON block were collected. CM was diagnosed using International Classification of Headache Disorders (ICHD-3). GON blocks were repeated every week in the first month and monthly thereafter for the following 6 months. The injections were performed radially at 2 cm lateral and 2 cm inferior to the protuberantia occipitalis externa with a needle and 2 mL of 0.25% bupivacaine bilaterally. Headache attack frequency (days), headache duration (hours) and severity of pain (Visual Analog Scale (VAS)) were compared between before and after GON block in the first month.
Results: Headache attack frequency decreased from 12.8 (8.4) (pretreatment) to 3.8 (3.5), and headache severity (VAS), from 8.5 (1.2) to 4.5 (1.8) (P<0.001 for both) within one month. No serious adverse effects were observed.
Conclusion: This study showed significant decreases in headache parameters in CM. GON block is widely used effectively in CM treatment, and there is a need to standardize the application technique, dose, and frequency.

Anahtar Kelimeler

Chronic migraine, Greater occipital nerve block, Headache attack frequency, Headache severity

Kaynakça

• 1. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia. 2013;33:629–808.
• 2. Gul HL, Ozon AO, Karadas O, Koc G, Inan LE. The efficacy of greater occipital nerve blockade in chronic migraine: A placebo‐controlled study. Acta Neurol Scand. 2017;136(2):138-44. doi: 10.1111/ane.12716
• 3. May A, Schulte LH. Chronic migraine: risk factors, mechanisms and treatment. Nat Rev Neurol. 2016;12(8):455-64. doi:10.1038/nrneurol.2016.93
• 4. Buse DC, Manack AN, Fanning KM, Serrano D, Reed ML, Turkel CC, et al. Chronic migraine prevalence, disability, and sociodemographic factors: results from the American Migraine Prevalence and Prevention Study. Headache. 2012;52(10):1456-70. doi: 10.1111/j.1526-4610.2012.02223.x
• 5. Unal-Artık HA, Inan LE, Atac-Ucar C, Yoldas TK. Do bilateral and unilateral greater occipital nerve block effectiveness differ in chronic migraine patients?. Neurol Sci. 2017;38(6):949-54. doi:10.1007/s10072-017-2861-5
• 6. Blumenfeld AM, Aurora SK, Laranjo K, Papapetropoulos S. Unmet clinical needs in chronic migraine: rationale for study and design of COMPEL, an open-label, multicenter study of the long-term efficacy, safety, and tolerability of onabotulinumtoxinA for headache prophylaxis in adults with chronic migraine. BMC Neurol. 2015;15:100. doi: 10.1186/s12883-015-0353-x
• 7. Sun-Edelstein C, Rapoport AM. Update on the pharmacological treatment of chronic migraine. Curr Pain Headache Rep. 2016;20(1):6. doi: 10.1007/s11916-015-0533-9
• 8. Allen SM, Mookadam F, Cha SS, Freeman JA, Starling AJ, Mookadam M. Greater occipital nerve block for acute treatment of migraine headache: a large retrospective cohort study. J Am Board Fam Med. 2018;31(2):211-8. doi: 10.3122/jabfm.2018.02.170188
• 9. Afridi SK, Shields KG, Bhola R, Goadsby PJ. Greater occipital nerve injection in primary headache syndromes–prolonged effects from a single injection. Pain. 2006;122(1–2):126–9. doi: 10.1016/j.pain.2006.01.016
• 10. Ashkenazi A, Matro R, Shaw JW, Abbas MA, 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;79:415–7. doi: 10.1136/jnnp.2007.124420
• 11. Ashkenazi A, Blumenfeld A, Napchan U, et al. Peripheral nerve blocks and trigger point injections in headache management - a systematic review and suggestions for future research. Headache. 2010;50:943–52. doi: 10.1111/j.1526-4610.2010.01675.x
• 12. Ozer D, Boluk C, Turk Boru U, Altun D, Tasdemir M, Koseoglu Toksoy C. Greater occipital and supraorbital nerve blockade for the preventive treatment of migraine: a single-blind, randomized, placebo-controlled study. Curr Med Res Opin. 2019;35(5):909-15. doi: 10.1080/03007995.2018.1532403
• 13. Tobin JA, Fitman SS. Occipital nerve blocks: effect of symptomatic medication overuse and headache type on failure rate. Headache. 2009;49(10):1479–85. doi: 10.1111/j.1526-4610.2009.01549.x
• 14. Gawel MJ, Rothbart PJ. Occipital nerve block in the management of headache and cervical pain. Cephalalgia. 1992;12:9–13. doi: 10.1046/j.1468-2982.1992.1201009.x
• 15. Inan N, Ceyhan A, Inan L, Kavaklioğlu O, Alptekin A, Unal A. C2/C3 nerve blocks and greater occipital nerve block in cervicogenic headache treatment. Funct Neurol. 2001;16:239–43. PMID: 11769869
• 16. Karadas O, Gul HL, Inan LE. Lidocaine injection of pericranial myofascial trigger points in the treatment of frequent episodic tension‐type headache. J Headache Pain. 2013;14:44–51. doi: 10.1186/1129-2377-14-44
• 17. Zhang H, Yang X, Lin Y, Chen L, Ye H. The efficacy of greater occipital nerve block for the treatment of migraine: a systematic review and meta-analysis. Clin Neurol Neurosurg. 2018;165:129-33. doi: 10.1016/j.clineuro.2017.12.026
• 18. Terzi T, Karakurum B, Üçler S, İnan LE, Tulunay C. Greater occipital nerve blockade in migraine, tension‐type headache and cervicogenic headache. J Headache Pain. 2002;3:137–41. doi: 10.1007/s101940200031
• 19. Inan LE, Inan N, Karadas O, Gul HL, Erdemoglu AK, Turkel Y, et al. Greater occipital nerve blockade for the treatment of chronic migraine: A randomized, multicenter, double‐blind, and placebo‐controlled study. Acta Neurol Scand. 2015;132(4):270-7. doi: 10.1111/ane.12393
• 20. Cuadrado, ML, Aledo-Serrano, Á, Navarro, P Short-term effects of greater occipital nerve blocks in chronic migraine: A double-blind, randomised, placebo-controlled clinical trial. Cephalalgia. 2017;37:864–72. doi: 10.1177/0333102416655159
• 21. Inan LE, Inan N, Unal-Artık HA, Atac C, Babaoglu G. Greater occipital nerve block in migraine prophylaxis: narrative review. Cephalalgia. 2019;39(7):908-20. doi: 10.1177/0333102418821669
• 22. Inan, N, Inan LE, Coskun O. Effectiveness of greater occipital nerve blocks in migraine prophylaxis. Arch Neuropsychiatr. 2016;53:45–8. doi: 10.5152/npa.2015.10003
• 23. Dilli E, Halker R, Vargas B, Hentz J, Radam T, Rogers R, et al. Occipital nerve block for the short-term preventive treatment of migraine: A randomized, double-blinded, placebo-controlled study. Cephalalgia. 2015;35:959–68. doi: 10.1177/0333102414561872
• 24. Su M, Yu S. Chronic migraine: A process of dysmodulation and sensitization. Mol Pain 2018;14:1-10. doi:10.1177/1744806918767697
• 25. Okmen K, Dagistan Y, Dagistan E, Kaplan N, Cancan E. Efficacy of the greater occipital nerve block in recurrent migraine type headaches. Neurol Neurochir Pol. 2016;50:151–4. doi: 10.1016/j.pjnns.2016.01.015
• 26. Blumenfeld A, Ashkenazi A, Napchan U, Bender SD, Klein BC, Berliner R,et al. Expert consensus recommendations for the performance of peripheral nerve blocks for headaches–a narrative review. Headache 2013;53(3): 437-446. doi: 10.1111/head.12053
• 27. Tang Y, Kang J, Zhang Y, Zhang X. Influence of greater occipital nerve block on pain severity in migraine patients: A systematic review and meta-analysis. Am J Emerg Med. 2017; 35(11):1750-4. doi: 10.1016/j.ajem.2017.08.027
• 28. Kashipazha D, Nakhostin-Mortazavi A, Mohammadianinejad SE, Bahadoram M, Zandifar S, Tarahomi S. Preventive effect of greater occipital nerve block on severity and frequency of migraine headache. Glob J Health Sci. 2014;6:209-13. doi: 10.5539/gjhs.v6n6p209