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Giuliani G, Viganò A, Papini F, Petolicchio B, Toscano M, Vicenzini E, Di Piero V, Altieri M. Greater Occipital Nerve Block as Preventive Treatment in Migraine: A Time-To-Event Analysis. Pain Pract 2025; 25:e70041. [PMID: 40375814 DOI: 10.1111/papr.70041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2025] [Accepted: 05/05/2025] [Indexed: 05/18/2025]
Abstract
INTRODUCTION Greater occipital nerve block (GON-B) may still represent a valuable strategy in migraine prophylaxis despite the development of newer drugs. The absence of a standardized method leads to variable outcomes and limits its use. In this light, we investigated GON-B effects in a migraine population trying to define its duration and response predictors. METHODS In this real-world study, we recruited patients with migraine who underwent bilateral GON-B. They were clinically evaluated at baseline and then monthly for the next 3 months, using a 30-day headache diary. The potential role of baseline headache characteristics in predicting treatment response was thoroughly analyzed. RESULTS A total of 73 patients were enrolled: 50 (68%) were affected by chronic migraine while 38 (52%) by medication overuse headache (MOH). The greatest clinical benefit due to GON-B was reported during the first month, although the therapeutic response was substantially maintained during follow-up. Notably, similar outcomes were recorded in patients with and without MOH. The mean duration of effect was 55.3 ± 72.0 days, with no clinical variables significantly influencing this parameter. The therapeutic response seemed to be stronger in patients with migraine with aura. CONCLUSIONS GON-B appears an effective option in migraine prophylaxis, even in difficult-to-treat patients. Its rapid effect, high tolerability, and cost-effectiveness represent indisputable advantages. A prolonged duration of action, which could be favored by the combination of anesthetic and steroid and needs to be confirmed in future studies, may further optimize patient management.
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Affiliation(s)
- Giada Giuliani
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | | | - Federica Papini
- Department of Neurology, University of Piemonte Orientale, Novara, Italy
| | - Barbara Petolicchio
- Department of Neurology and Neurophysiopathology, Sandro Pertini Hospital, Rome, Italy
| | | | - Edoardo Vicenzini
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Vittorio Di Piero
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
- University Consortium for Adaptive Disorders and Head Pain (UCADH), Pavia, Italy
| | - Marta Altieri
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
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Taha NA, Fathy M, Elsadek A, Emara TH, Farag SM, Moustafa RR, Abdulghani MO. Efficacy and safety of ultrasound-guided peripheral nerve blocks in management of chronic resistant migraine. J Headache Pain 2025; 26:80. [PMID: 40240919 PMCID: PMC12004780 DOI: 10.1186/s10194-025-02013-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2025] [Accepted: 03/24/2025] [Indexed: 04/18/2025] Open
Abstract
BACKGROUND Migraine is a common primary headache disorder with different treatment modalities emerging as ultrasound guided peripheral nerve blocks. We compared the efficacy and safety of ultrasound guided bilateral sphenopalatine ganglion (SPG) block versus bilateral greater occipital nerve (GON) block, in chronic resistant migraine patients and controls. METHODS This study was an interventional randomized controlled trial, including 53 patients, 22 in sphenopalatine ganglion arm, 21 greater occipital nerve arm and 10 in sham group. All patients were assessed initially by headache diary (for 3 months), HIT-6 and MIDAS scales. The patients (blindly allocated) underwent nerve block ultrasound guided, then followed up after one month by headache diary and HIT- 6 scale and three months by MIDAS. Results were analysed on SPSS, using mixed AVOVA and Tukey's Post-Hoc analysis, Fisher's exact and paired t-test. RESULTS The two groups were matched as regards the gender, age, type of migraine, frequency and years lived with headache. The study revealed that GON and SPG block, were equally effective (p < 0.05) as regards reducing the headache diary parameters, as well as the total pain index and the functional impact on HIT-6 and MIDAS scale. SPG block was more effective in patients with autonomic manifestations and temporal location of pain. CONCLUSION Ultrasound guided SPG is as effective as GON as a treatment modality for chronic resistant migraine and may be more useful in the presence of autonomic manifestations and temporal location of pain.
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Affiliation(s)
- Nourhan Abdelmohsen Taha
- Department of Neurology, Faculty of Medicine, Ain Shams University, 38 Abbasia, PO 11591, Cairo, Egypt
| | - Mai Fathy
- Department of Neurology, Faculty of Medicine, Ain Shams University, 38 Abbasia, PO 11591, Cairo, Egypt
| | - Ahmed Elsadek
- Department of Neurology, Faculty of Medicine, Ain Shams University, 38 Abbasia, PO 11591, Cairo, Egypt
| | - Tamer Hussein Emara
- Department of Neurology, Faculty of Medicine, Ain Shams University, 38 Abbasia, PO 11591, Cairo, Egypt
| | - Sherien Mohamed Farag
- Department of Neurology, Faculty of Medicine, Ain Shams University, 38 Abbasia, PO 11591, Cairo, Egypt
| | - Ramez Reda Moustafa
- Department of Neurology, Faculty of Medicine, Ain Shams University, 38 Abbasia, PO 11591, Cairo, Egypt.
| | - Mohamad Osama Abdulghani
- Department of Neurology, Faculty of Medicine, Ain Shams University, 38 Abbasia, PO 11591, Cairo, Egypt
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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; 25:62. [PMID: 39948478 PMCID: PMC11823226 DOI: 10.1186/s12883-025-04070-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2024] [Accepted: 02/05/2025] [Indexed: 02/17/2025] Open
Abstract
OBJECTIVE This study aimed to compare the short-term prophylactic efficacy of greater occipital nerve (GON) blockade in menstrual migraine (MM) subgroups and evaluate the long-term effects on patients' quality of life. METHODS In this prospective study, 33 patients diagnosed with MM (15 with pure menstrual migraine [PMM] and 18 with menstrually related migraine [MRM]) received bilateral GON blockade once a month, one week before menstrual bleeding, for three months. Patients were evaluated before treatment (month 0) and after treatment completion (months 3 and 6) using the Visual Analog Scale (VAS), Headache Impact Test-6 (HIT-6), Migraine Disability Assessment (MIDAS), and Beck Depression Inventory (BDI) scores. RESULTS MRM patients had a lower age of MM onset (p = 0.024), higher headache frequency (p = 0.004), and increased medication overuse (p = 0.027) compared to PMM patients. After GON blockade, significant improvements were observed in VAS, HIT-6, MIDAS, and BDI scores in both subgroups, with no significant differences between them. The improvement persisted during the medication-free follow-up period (months 3-6). Patients with mild or no depression showed a more substantial increase in quality of life. Patients experiencing a 50% reduction in headache days demonstrated significant improvement in BDI scores. CONCLUSION GON blockade may be an effective option for short-term and long-term prophylaxis in the treatment of MM, reducing the frequency and severity of headaches and improving quality of life and psychological state. Further research with larger patient cohorts and placebo-controlled trials is necessary to validate these findings.
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Affiliation(s)
- Guldeniz Cetin
- Sancaktepe Sehit Prof. Dr. İlhan Varank Research and Training Hospital, Istanbul, Turkey.
| | - Ozlem Totuk
- Sancaktepe Sehit Prof. Dr. İlhan Varank Research and Training Hospital, Istanbul, Turkey
| | - Ozdem Erturk Cetin
- Sancaktepe Sehit Prof. Dr. İlhan Varank Research and Training Hospital, Istanbul, Turkey
| | - Serkan Demir
- Sancaktepe Sehit Prof. Dr. İlhan Varank Research and Training Hospital, Istanbul, Turkey
| | - Sevki Sahin
- Sancaktepe Sehit Prof. Dr. İlhan Varank Research and Training Hospital, Istanbul, Turkey
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Şahin O, Güneş M, Şahin EHK, Dönmez R. The effect of greater occipital nerve block on amplification of somatic symptoms and anxiety and depression levels in chronic migraine. Acta Neurol Belg 2024; 124:1641-1646. [PMID: 38814378 DOI: 10.1007/s13760-024-02585-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 05/14/2024] [Indexed: 05/31/2024]
Abstract
OBJECTIVES It is known that chronic migraine (CM) is often accompanied by anxiety, depression, and psychosomatic complaints. We designed this study with the assumption that greater occipital nerve (GON) block treatment could potentially improve not only pain symptoms but also psychosomatic complaints. This study aimed to evaluate the changes in the visual analog scale (VAS), somatosensory amplification scale (SSAS), beck depression ınventory (BDI), and beck anxiety ınventory (BAI) with GON block treatment in patients with CM. METHODS This study was conducted retrospectively on 164 patients with CM between December 2018 and January 2023. Patients underwent six sessions of GON block treatment at weeks 0, 1, 2, 3, 5, and 7. VAS, SSAS, BAI, and BDI scores; number of attacks per month (NAM); attack pain duration (APD); and monthly use of analgesics (UA) were compared before the start and at week 8 of GON block treatment. RESULTS The mean age of the subjects was 38 ± 9 years. Statistical analysis revealed that VAS, SSAS, BAI, and BDI scores; NAM; APD; and monthly UA were statistically significantly lower following GON block treatment than before GON block treatment (p < 0.001 each). CONCLUSION GON block treatment was effective for pain and somatic complaints (amplification of physical symptoms), anxiety, and depressive symptoms accompanying CM in patients with CM.
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Affiliation(s)
- Oruç Şahin
- Neurology Clinic, Aksaray University Training and Research Hospital, Aksaray, Turkey.
| | - Muzaffer Güneş
- Neurology Clinic, Aksaray University Training and Research Hospital, Aksaray, Turkey
| | | | - Recep Dönmez
- Neurology Clinic, Aksaray University Training and Research Hospital, Aksaray, Turkey
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Tanyel Saraçoğlu T, Bılır A, Güleç MS. Effectiveness of combining greater occipital nerve block and pulsed radiofrequency treatment in patients with chronic migraine: a double-blind, randomized controlled trial. Head Face Med 2024; 20:48. [PMID: 39256847 PMCID: PMC11389420 DOI: 10.1186/s13005-024-00449-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Accepted: 08/26/2024] [Indexed: 09/12/2024] Open
Abstract
BACKGROUND Pulsed radiofrequency (PRF) treatment targeting the greater occipital nerve (GON) has shown efficacy in treating various conditions. This double-blind, randomized controlled study aimed to evaluate the effects of combining PRF therapy with GON block (GONB) therapy in patients with chronic migraine. METHODS The study consisted of two groups: GONB and GONB + PRF, each comprising 16 patients with chronic migraine. Using 0.5-Hz sensorial stimulation, a 5-cm-long radiofrequency needle was inserted under ultrasound guidance in both groups. Subsequently, all patients received a GONB by administering 2 mL of 0.25% bupivacaine. In the GONB + PRF group, patients underwent 4 min of PRF at 42℃, whereas the GONB group did not receive any PRF treatment. Follow-up examinations were performed at 1, 2, 3 and 6 months after the procedure to evaluate the frequency and severity of migraine attacks, number of headache days, and analgesic consumption. RESULTS In the GONB + PRF group, the visual analog scale (VAS) score, number of migraine attacks, number of headache days, and analgesic consumption were significantly lower compared to the GONB group (P < 0.05). Significant decreases (60%) in mean VAS scores, number of migraine attacks, number of headache days, and consumption of analgesic medications were observed in the GONB + PRF group at the 1-, 2-, 3-, and 6-month follow-ups compared with the pre-treatment period (P < 0.05). CONCLUSIONS The combination of GONB and PRF presents a promising new treatment option for patients with chronic migraine. This approach has demonstrated efficacy in minimizing analgesic use, decreasing the frequency of migraine attacks, reducing the number of headache days and decreasing the severity of migraine attacks. TRIAL REGISTRATION NCT05464212.
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Affiliation(s)
- Tuba Tanyel Saraçoğlu
- Department of Pain Management, Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey.
| | - Ayten Bılır
- Depatment of Pain Management, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Mehmet Sacit Güleç
- Depatment of Pain Management, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
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Mustafa MS, Bin Amin S, Kumar A, Shafique MA, Fatima Zaidi SM, Arsal SA, Rangwala BS, Iqbal MF, Raja A, Haseeb A, Jawed I, Hussien Mohamed Ahmed KA, Muhammad Sinaan Ali S, Varrassi G. Assessing the effectiveness of greater occipital nerve block in chronic migraine: a systematic review and meta-analysis. BMC Neurol 2024; 24:330. [PMID: 39244547 PMCID: PMC11380438 DOI: 10.1186/s12883-024-03834-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 08/28/2024] [Indexed: 09/09/2024] Open
Abstract
BACKGROUND & AIMS Chronic migraine poses a global health burden, particularly affecting young women, and has substantial societal implications. This study aimed to assess the efficacy of Greater Occipital Nerve Block (GONB) in individuals with chronic migraine, focusing on the impact of local anesthetics compared with placebo. METHODS A meta-analysis and systematic review were conducted following the PRISMA principles and Cochrane Collaboration methods. Eligible studies included case-control, cohort, and randomized control trials in adults with chronic migraine, adhering to the International Classification of Headache Disorders, third edition (ICHD3). Primary efficacy outcomes included headache frequency, duration, and intensity along with safety assessments. RESULTS Literature searches across multiple databases yielded eight studies for qualitative analysis, with five included in the final quantitative analysis. A remarkable reduction in headache intensity and frequency during the first and second months of treatment with GONB using local anesthetics compared to placebo has been reported. The incidence of adverse events did not differ significantly between the intervention and placebo groups. CONCLUSION The analysis emphasized the safety and efficacy of GONB, albeit with a cautious interpretation due to the limited number of studies and relatively small sample size. This study advocates for further research exploring various drugs, frequencies, and treatment plans to enhance the robustness and applicability of GONB for chronic migraine management.
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Affiliation(s)
- Muhamad Saqlain Mustafa
- Department of Medicine, Jinnah Sindh Medical University, Karachi, 75510, Pakistan
- Jinnah Sindh Medical University, Rafiqi H J Shaheed Road, Karachi, 75510, Pakistan
| | - Shafin Bin Amin
- Department of Medicine, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, 75400, Pakistan
- Shaheed Mohtarma Benazir Bhutto Medical College, Lyari Hospital Rd, Rangiwara Karachi, Karachi, 75400, Pakistan
| | - Aashish Kumar
- Department of Medicine, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, 75400, Pakistan
- Shaheed Mohtarma Benazir Bhutto Medical College, Lyari Hospital Rd, Rangiwara Karachi, Karachi, 75400, Pakistan
| | - Muhammad Ashir Shafique
- Department of Medicine, Jinnah Sindh Medical University, Karachi, 75510, Pakistan
- Jinnah Sindh Medical University, Rafiqi H J Shaheed Road, Karachi, 75510, Pakistan
| | - Syeda Mahrukh Fatima Zaidi
- Department of Medicine, Dow University of Health Science, Karachi, 74200, Pakistan
- Dow University of Health Sciences, Mission Rd, New Labour Colony Nanakwara, Karachi, 74200, Pakistan
| | - Syed Ali Arsal
- Department of Medicine, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, 75400, Pakistan
- Shaheed Mohtarma Benazir Bhutto Medical College, Lyari Hospital Rd, Rangiwara Karachi, Karachi, 75400, Pakistan
| | - Burhanudin Sohail Rangwala
- Department of Medicine, Jinnah Sindh Medical University, Karachi, 75510, Pakistan
- Jinnah Sindh Medical University, Rafiqi H J Shaheed Road, Karachi, 75510, Pakistan
| | - Muhammad Faheem Iqbal
- Department of Medicine, Dow University of Health Science, Karachi, 74200, Pakistan
- Dow University of Health Sciences, Mission Rd, New Labour Colony Nanakwara, Karachi, 74200, Pakistan
| | - Adarsh Raja
- Department of Medicine, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, 75400, Pakistan
- Shaheed Mohtarma Benazir Bhutto Medical College, Lyari Hospital Rd, Rangiwara Karachi, Karachi, 75400, Pakistan
| | - Abdul Haseeb
- Department of Medicine, Jinnah Sindh Medical University, Karachi, 75510, Pakistan
- Jinnah Sindh Medical University, Rafiqi H J Shaheed Road, Karachi, 75510, Pakistan
| | - Inshal Jawed
- Department of Medicine, Dow University of Health Science, Karachi, 74200, Pakistan
- Dow University of Health Sciences, Mission Rd, New Labour Colony Nanakwara, Karachi, 74200, Pakistan
| | | | - Syed Muhammad Sinaan Ali
- Department of Medicine, Liaquat National Hospital and Medical College, Karachi, Pakistan
- Liaquat National Hospital & Medical College, Stadium Road, Karachi, 74800, Pakistan
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Gürsoy G, Tuna HA. Comparison of two methods of greater occipital nerve block in patients with chronic migraine: ultrasound-guided and landmark-based techniques. BMC Neurol 2024; 24:311. [PMID: 39232647 PMCID: PMC11373286 DOI: 10.1186/s12883-024-03816-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Accepted: 08/21/2024] [Indexed: 09/06/2024] Open
Abstract
BACKGROUND Migraine is a primary headache defined as moderate-to-severe pain lasting 4 to 72 h, ranking 2nd among the disabling conditions for both genders regardless of the age and the greater occipital nerve (GON) block has been reported as an efficient treatment method for migraine. The present study aims to evaluate and compare the efficiency of the two methods of GON block, i.e., the ultrasound (US)-guided technique and the landmark-based technique. METHOD Having a prospective and randomized design, the study assigned the patients with chronic migraine into two groups after which a neurologist performed landmark-based GON block in the first group while an algologist performed US-guided GON block in the second group. During the 3-month follow-up period, the number of days with pain, the duration of pain, the number of analgesic drugs taken in a month, and Visual Analogue Scale (VAS) scores were compared with the values before treatment and at the 1st week, 1st month, and 3rd month after treatment. RESULTS US-guided GON block group included 34 patients while there were 32 patients in the landmark-based GON block group. US-guided GON block group showed significantly reduced VAS scores and frequency of attacks compared to the landmark-based GON block group at Month 1 after the procedure. After a 3-month follow-up period of the two groups, the frequency of attacks, analgesic intake and the duration of attacks were lower in both groups compared to the baseline. At 3-month follow-up, the mean of VAS scores decreased from 9,47 ± 2,69 to 4,67 ± 1,9 in US-guided GON block group and from 9,46 ± 0,98 to 7 ± 2,5 in the landmark-based GON block group. CONCLUSION It was determined that both US-guided and landmark-based GON block were efficient techniques in patients with chronic migraine. US-guided GON block technique resulted in lower VAS scores, shorter durations of pain, lower frequencies of attack, and lower intake of analgesics compared to the landmark-based GON block technique.
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Affiliation(s)
- Gizem Gürsoy
- Neurology Department, Ümraniye Research and Training Hospital, İstanbul, Türkiye.
| | - Hale Arkan Tuna
- Algology Department, Ümraniye Research and Training Hospital, İstanbul, Türkiye
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Puledda F, Sacco S, Diener HC, Ashina M, Al-Khazali HM, Ashina S, Burstein R, Liebler E, Cipriani A, Chu MK, Cocores A, Dodd-Glover F, Ekizoğlu E, Garcia-Azorin D, Göbel CH, Goicochea MT, Hassan A, Hirata K, Hoffmann J, Jenkins B, Kamm K, Lee MJ, Ling YH, Lisicki M, Martinelli D, Monteith TS, Ornello R, Özge A, Peres MFP, Pozo-Rosich P, Romanenko V, Schwedt TJ, Souza MNP, Takizawa T, Terwindt GM, Thuraiaiyah J, Togha M, Vandenbussche N, Wang SJ, Yu S, Tassorelli C. International Headache Society Global Practice Recommendations for Preventive Pharmacological Treatment of Migraine. Cephalalgia 2024; 44:3331024241269735. [PMID: 39262214 DOI: 10.1177/03331024241269735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2024]
Affiliation(s)
- Francesca Puledda
- Headache Group, Wolfson SPaRC, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Hans-Christoph Diener
- Department of Neuroepidemiology, Institute for Medical Informatics, Biometry and Epidemiology, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
| | - Messoud Ashina
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Haidar M Al-Khazali
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Sait Ashina
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Neurology and Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, USA
| | - Rami Burstein
- Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, USA
| | | | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Min Kyung Chu
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Alexandra Cocores
- Department of Neurology-Headache Division, University of Miami, Miller School of Medicine, Miami, USA
| | - Freda Dodd-Glover
- Department of Medicine and Therapeutics, Korle Bu Teaching Hospital, Accra, Ghana
| | - Esme Ekizoğlu
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - David Garcia-Azorin
- Department of Neurology, Hospital Universitario Rio Hortega, University of Valladolid, Valladolid, Spain
| | - Carl H Göbel
- Kiel Migraine and Headache Centre, Kiel, Germany
- Department of Neurology, Christian-Albrechts University, Kiel, Germany
| | | | - Amr Hassan
- Department of Neurology, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Koichi Hirata
- Neurology, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Jan Hoffmann
- Wolfson Sensory, Pain and Regeneration Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Katharina Kamm
- Department of Neurology, Klinikum der Universitat Munchen, Munich, Germany
| | - Mi Ji Lee
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yu-Hsiang Ling
- Neurological Institute, Taipei Veterans General Hospital, Taipei
- College of Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Marco Lisicki
- Instituto de Investigación Médica Mercedes y Martin Ferreyra (INIMEC), Consejo Nacional de Investigaciones Cientificas y Técnicas (CONICET), Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Daniele Martinelli
- IRCCS Mondino Foundation, Headache Science and Rehabilitation Unit, Pavia, Italy
| | - Teshamae S Monteith
- Department of Neurology-Headache Division, University of Miami, Miller School of Medicine, Miami, USA
| | - Raffaele Ornello
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Aynur Özge
- Department of Neurology, Mersin University School of Medicine, Mersin, Turkey
| | | | - Patricia Pozo-Rosich
- Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron & Headache & Neurological Pain Research Group, Vall d'Hebron Institute of Research, Barcelona, Spain
| | | | | | | | - Tsubasa Takizawa
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Gisela M Terwindt
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Janu Thuraiaiyah
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Mansoureh Togha
- Neurology ward, Sina Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Headache department, Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Nicolas Vandenbussche
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
- Department of Neurology, AZ Sint-Jan Brugge, Bruges, Belgium
| | - Shuu-Jiun Wang
- Neurological Institute, Taipei Veterans General Hospital, Taipei
- College of Medicine, National Yang Ming Chiao Tung University, Taipei
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei
| | - Shenguan Yu
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Cristina Tassorelli
- IRCCS Mondino Foundation, Headache Science and Rehabilitation Unit, Pavia, Italy
- Department of Brain and Behavioral Science, University of Pavia, Pavia, Italy
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9
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Karaoğlan M. Addressing limitations of single GON blockade treatment and repetitive intervention with GON block or onabotulinum toxin A in chronic migraine- part 2 of three men in a boat study. Clin Neurol Neurosurg 2024; 240:108242. [PMID: 38518628 DOI: 10.1016/j.clineuro.2024.108242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 03/09/2024] [Accepted: 03/10/2024] [Indexed: 03/24/2024]
Abstract
This study investigated the effectiveness of three treatment interventions for managing migraine symptoms over a three-month assessment period: single greater occipital nerve block (GON), repetitive GON block, and single GON block combined with onabotulinium toxin A (BoNT-A) treatment. Significant improvements were observed across all treatment groups in various migraine-related parameters, including medication usage, frequency and severity of attacks, and subjective measures such as Headache Impact Test-6 scores and Pittsburgh Sleep Quality Index scores. Notably, all groups showed reductions in NSAID and triptan usage, total number of attacks with VAS>4, and number of headache days. However, slight differences in the magnitude of improvements were observed between the groups, with GON block combined with BoNT-A treatment demonstrating slightly greater reductions compared to single GON block treatment. Additionally, the integration of BoNT-A therapy alongside GON blockade appeared to confer supplementary benefits in migraine prophylaxis. These findings highlight the importance of implementing comprehensive treatment approaches to address various aspects of migraine management and improve patient outcomes.
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10
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Chang IA, Wells MW, Wang GM, Tatsuoka C, Guyuron B. Nonpharmacologic Treatments for Chronic and Episodic Migraine: A Systematic Review and Meta-Analysis. Plast Reconstr Surg 2023; 152:1087-1098. [PMID: 36940145 DOI: 10.1097/prs.0000000000010429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
BACKGROUND Minimally invasive techniques for treatment-resistant migraine have been developed on recent insights into the peripheral pathogenesis of migraines. Although there is a growing body of evidence supporting these techniques, no study has yet compared the effects of these treatments on headache frequency, severity, duration, and cost. METHODS PubMed, Embase, and Cochrane Library databases were searched to identify randomized placebo-controlled trials that compared radiofrequency ablation, botulinum toxin type A (BT-A), nerve block, neurostimulation, or migraine surgery to placebo for preventive treatment. Data on changes from baseline to follow-up in headache frequency, severity, duration, and quality of life were analyzed. RESULTS A total of 30 randomized controlled trials and 2680 patients were included. Compared with placebo, there was a significant decrease in headache frequency in patients with nerve block ( P = 0.04) and surgery ( P < 0.001). Headache severity decreased in all treatments. Duration of headaches was significantly reduced in the BT-A ( P < 0.001) and surgery cohorts ( P = 0.01). Quality of life improved significantly in patients with BT-A, nerve stimulator, and migraine surgery. Migraine surgery had the longest lasting effects (11.5 months) compared with nerve ablation (6 months), BT-A (3.2 months), and nerve block (11.9 days). CONCLUSIONS Migraine surgery is a cost-effective, long-term treatment to reduce headache frequency, severity, and duration without significant risk of complication. BT-A reduces headache severity and duration, but it is short-lasting and associated with greater adverse events and lifetime cost. Although efficacious, radiofrequency ablation and implanted nerve stimulators have high risks of adverse events and explantation, whereas benefits of nerve blocks are short in duration.
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Affiliation(s)
| | | | - Gi-Ming Wang
- Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine
| | - Curtis Tatsuoka
- Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine
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Bushman ET, Blanchard CT, Cozzi GD, Davis AM, Harper L, Robbins LS, Jones B, Szychowski JM, Digre KB, Casey BM, Tita AT, Sinkey RG. Occipital Nerve Block Compared With Acetaminophen and Caffeine for Headache Treatment in Pregnancy: A Randomized Controlled Trial. Obstet Gynecol 2023; 142:1179-1188. [PMID: 37769308 PMCID: PMC10591891 DOI: 10.1097/aog.0000000000005386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 07/20/2023] [Indexed: 09/30/2023]
Abstract
OBJECTIVE To evaluate the efficacy of occipital nerve block compared with standard care , defined as acetaminophen with caffeine, for treatment of acute headache in pregnancy. METHODS We conducted a single-center, unblinded, parallel, randomized controlled trial of pregnant patients with headache and pain score higher than 3 on the visual rating scale. Patients with secondary headache, preeclampsia, or allergy or contraindication to study medications were excluded. Participants were randomized to occipital nerve block or standard care (oral 650 mg acetaminophen and 200 mg caffeine). Crossover treatment was given at 2 hours and second-line treatment at 4 hours to those with worsening visual rating scale score or visual rating scale score higher than 3. The primary outcome was headache improvement to a visual rating scale score of 3 or lower within 2 hours of initial therapy. Secondary outcomes included serial visual rating scale scores, receipt of crossover or second-line therapy, patient satisfaction, and perinatal outcomes. Outcomes were assessed in an intention-to-treat analysis. We estimated that a sample of 62 would provide 80% power to detect a difference from 85% to 50% between groups. RESULTS From February 2020 to May 2022, 62 participants were randomized to occipital nerve block (n=31) or standard care (n=31). Groups were similar except payer status. The primary outcome, headache improvement to visual rating scale score of 3 or lower, was not significantly different between groups (64.5% vs 51.6%, P =.30). The occipital nerve block group experienced lower median [interquartile range] visual rating scale scores at 1 hour (2 [0-5] vs 6 [2-7], P =.014), and more patients in the occipital nerve block group had visual rating scale scores of 3 or lower at 1 hour. Among patients receiving crossover treatment at 2 hours, the standard care group had a significantly lower visual rating scale score 1 hour after crossover to occipital nerve block than the occipital nerve block group receiving crossover to standard care ( P =.028). There were no significant differences in second-line treatment, refractory headache, satisfaction, or complications. Patients receiving occipital nerve block delivered earlier (36.6 weeks vs 37.8 weeks), but preterm birth did not differ between groups. CONCLUSION Occipital nerve block is an effective and quick-acting treatment option for acute headache in pregnancy. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov , NCT03951649.
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Affiliation(s)
- Elisa T Bushman
- Center for Women's Reproductive Health, the Department of Obstetrics and Gynecology, the Department of Biostatistics, and the Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama; the Department of Women's Health, University of Texas at Austin, Dell Medical School, Austin, Texas; and the Department of Neuro-ophthalmology, University of Utah, Salt Lake City, Utah
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Evcili G, Yabalak A. Evaluation of the efficacy of peripheral nerve block alone in episodic and chronic migraine patients. ARQUIVOS DE NEURO-PSIQUIATRIA 2023; 81:734-739. [PMID: 37536366 PMCID: PMC10468243 DOI: 10.1055/s-0043-1771494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 10/06/2022] [Indexed: 08/05/2023]
Abstract
BACKGROUND Peripheral nerve block (PNB) is usually performed in patients with migraine who are resistant to treatment with medications. OBJECTIVE To compare the efficacy of PNB alone and PNB combined with prophylactic medications in migraine patients. METHOD The data on migraine patients who underwent PNB in our clinic between November 2019 and January 2022 were retrospectively reviewed. Blocks of the greater occipital nerve (GON), lesser occipital nerve (LON) and supraorbital nerve (SON) were performed upon admission and in the second week. RESULTS The study included 116 patients. While 21 out of 39 episodic migraine (EM) patients continued to use prophylactic medications, 18 were followed up with PNB alone. While 49 out of 77 chronic migraine (CM) patients continued to use prophylactic medications, 28 were followed up with PNB alone. Comparison of the admission and second-month data of the patients who only underwent PNB and those who continued the drug treatment together with PNB in both the EM and the CM group showed that the number of days with pain, number of analgesics taken and scores on the Visual Analog Scale (VAS) and the Migraine Disability Assessment (MIDAS) were significantly reduced in both groups (p < 0.01). Comparison of the second-month data of the patients followed up with PNB alone and those followed up with PNB together with prophylactic medications showed that there was no significant difference between the EM and CM patients (p > 0.05). CONCLUSION Bilateral GON, LON and SON block with lidocaine injection seems to be an effective treatment on its own, without the need for prophylactic medications, in both EM and CM patients during a two-month follow-up.
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Affiliation(s)
- Gokhan Evcili
- University of Health Sciences, Derince Training and Research Hospital, Department of Neurology, Kocaeli, Turkey.
| | - Ahmet Yabalak
- Duzce University, Faculty of Medicine, Department of Neurology, Duzce, Turkey.
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13
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Castillo-Álvarez F, Hernando de la Bárcena I, Marzo-Sola ME. Greater occipital nerve block in the treatment of headaches. Review of evidence. Med Clin (Barc) 2023:S0025-7753(23)00177-X. [PMID: 37100680 DOI: 10.1016/j.medcli.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/01/2023] [Accepted: 04/04/2023] [Indexed: 04/28/2023]
Abstract
INTRODUCTION Peripheral nerve blocks have been a common treatment for multiple headaches. By far, the greater occipital nerve block is the most used and with the stronger body of evidence in routine clinical practice. METHODS We searched Pubmed Meta-Analysis/Systematic Review, in the last 10 years. Of these results, meta-analyses, and in the absence of these systematic reviews, assessing Greater Occipital Nerve Block in headache has been selected for review. RESULTS We identified 95 studies in Pubmed, 13 that met the inclusion criteria. CONCLUSION Greater occipital block is an effective and safe technique, easy to perform and which has shown its usefulness in migraine, cluster headache, cervicogenic headache and Post-dural puncture headache. However, more studies are needed to clarify its long-term efficacy, its place in clinical treatment, the possible difference between different anaesthetics, the most convenient dosage and the role of concomitant use of corticosteroids.
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Karaoğlan M. Three men in a boat: The comparison of the combination therapy of botulinum toxin and greater occipital nerve block with bupivacaine, with botulinum toxin monotherapy in the management of chronic migraine. Clin Neurol Neurosurg 2023; 226:107609. [PMID: 36731164 DOI: 10.1016/j.clineuro.2023.107609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/31/2022] [Accepted: 01/02/2023] [Indexed: 01/22/2023]
Abstract
OBJECTIVE This study compared the impact of the combination therapy of onabotulinum toxin A and greater occipital nerve block (GoNT-A) with onabotulinum toxin A monotherapy (BoNT-A) based on its efficacy and safety in relation to the quality of life of adult chronic migraine (CM) patients. BACKGROUND Prophylactic treatment of CM is still difficult and complex. Combination treatments do not have an evidence base yet. METHODS This retrospective study included 85 patients. For greater occipital nerve block (GONB), 4 ml of the solution prepared using 1 ml of 0.5% bupivacaine and 3 ml of saline on both sides were bilaterally applied to 30 patients. For BoNT-A treatment, a total of 155 units of onabotulinum toxin A (BOTOX®) was intramuscularly injected into 31 specific points around the head and neck in 27 patients. Both protocols were similarly applied to 28 patients for GoNT-A treatment. MIDAS and HIT-6 scores were evaluated to measure patients' quality of life three months after the treatment. RESULTS When MIDAS and HIT-6 score groups were statistically compared, both GONB and GoNT-A applications showed a statistically significant reduction compared to the BoNT-A application (p < 0.05). The decrease in the MIDAS and HIT-6 scores of GONB and GoNT-A applications did not show a statistical difference (p > 0.05). CONCLUSION The combination of BoNT-A and GONB was superior to BoNT-A applied as monotherapy. Alternately, no significant difference was found between GONB therapy and combination therapy in all data. Combination treatments were well tolerated.
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15
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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; 43:3331024221143541. [PMID: 36739512 DOI: 10.1177/03331024221143541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Greater occipital nerve blockade for the prevention of chronic migraine has a limited evidence base. A robust randomized double-blind, placebo-controlled trial is needed. METHODS This double-blind, placebo-controlled, parallel-group trial, following a baseline period of four weeks, randomly assigned patients of chronic migraine 1:1 to receive four-weekly bilateral greater occipital nerve blockade with either 2 ml of 2% (40 mg) lidocaine (active group) or 2 ml of 0.9% saline (placebo) injections for 12 weeks. The primary and key secondary efficacy endpoints were a change from the baseline in the mean number of headache and migraine days and the achievement of ≥50% reduction in headache days from baseline across the weeks 9-12 respectively. Safety evaluations included the documentation and reporting of serious and other adverse events. RESULTS Twenty-two patients each were randomly allocated to the active and placebo group. Baseline demography and clinical characteristics were similar between the two groups. Mean headache and migraine days at baseline (±SD) were 23.4 ± 4.4 and 15.6 ± 5.7 days in the active group and 22.6 ± 5.0 and 14.6 ± 4.6 days in the placebo group respectively. The active group compared to the placebo had a significantly greater least-squares mean reduction in the number of headache and migraine days (-4.2 days [95% CI: -7.5 to -0.8; p = 0.018] and -4.7 days [95%CI: -7.7 to -1.7; p = 0.003] respectively). 40.9% of patients in the active group achieved ≥50% reduction in headache days as compared with 9.1% of patients receiving a placebo (p = 0.024). Overall, 64 mild and transient adverse events were reported by 16 patients in the active group and 15 in the placebo. No death or serious adverse events were reported. CONCLUSION Four-weekly greater occipital nerve blockade with 2% lidocaine for 12 weeks was superior to placebo in decreasing the average number of headache and migraine days in patients with chronic migraine with a good tolerability profile.Clinical trial.gov no. CTRI 2020/07/026709.
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Affiliation(s)
- Debashish Chowdhury
- Department of Neurology, G B Pant institute of Post Graduate Medical Education and Research, Maulana Azad Medical College, New Delhi, India
| | - Apoorva Tomar
- Department of Neurology, G B Pant institute of Post Graduate Medical Education and Research, Maulana Azad Medical College, New Delhi, India
| | - Vaibhav Deorari
- Department of Neurology, G B Pant institute of Post Graduate Medical Education and Research, Maulana Azad Medical College, New Delhi, India
| | - Ashish Duggal
- Department of Neurology, G B Pant institute of Post Graduate Medical Education and Research, Maulana Azad Medical College, New Delhi, India
| | - Anand Krishnan
- Department of Community Medicine, All India Institute of Medical sciences, New Delhi, India
| | - Arun Koul
- Department of Neurology, G B Pant institute of Post Graduate Medical Education and Research, Maulana Azad Medical College, New Delhi, India
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Abstract
Chronic migraine is a neurologic disorder associated with considerable disability, lost productivity, and a profound economic burden worldwide. The past five years have seen a dramatic expansion in new treatments for this often challenging condition, among them calcitonin gene related peptide antagonists and neuromodulatory devices. This review outlines the epidemiology of and diagnostic criteria and risk factors for chronic migraine. It discusses evidence based drug and non-drug treatments, their advantages and disadvantages, and the principles of patient centered care for adults with chronic migraine, with attention to differential diagnosis and comorbidities, clinical reasoning, initiation and monitoring, cost, and availability. It discusses the international guidelines on drug treatment for chronic migraine and evaluates non-drug treatments including behavioral and complementary therapies and lifestyle modifications. Finally, it discusses the management of chronic migraine in special populations, including pediatrics, pregnancy, and older people, and considers future questions and emerging research in the field.
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Affiliation(s)
| | - Julie Roth
- Warren Alpert Medical School of Brown University, Brown University, Providence, RI, USA
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17
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Stern JI, Chiang C, Kissoon NR, Robertson CE. Narrative review of peripheral nerve blocks for the management of headache. Headache 2022; 62:1077-1092. [DOI: 10.1111/head.14385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/21/2022] [Accepted: 07/18/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Jennifer I. Stern
- Headache Division, Department of Neurology Mayo Clinic Rochester Minnesota USA
| | - Chia‐Chun Chiang
- Headache Division, Department of Neurology Mayo Clinic Rochester Minnesota USA
| | - Narayan R. Kissoon
- Headache Division, Department of Neurology Mayo Clinic Rochester Minnesota USA
- Division of Pain Medicine, Department of Anesthesiology Mayo Clinic Rochester Minnesota USA
| | - Carrie E. Robertson
- Headache Division, Department of Neurology Mayo Clinic Rochester Minnesota USA
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Velásquez-Rimachi V, Chachaima-Mar J, Cárdenas-Baltazar EC, Loayza-Vidalon A, Morán-Mariños C, Pacheco-Barrios K, Posso M, Alva-Díaz C. Greater occipital nerve block for chronic migraine patients: A meta-analysis. Acta Neurol Scand 2022; 146:101-114. [PMID: 35726455 DOI: 10.1111/ane.13634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 04/05/2022] [Accepted: 05/01/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Greater occipital nerve block (GONB) is a minimally invasive procedure frequently used in patients with chronic migraine (CM); however, the quality of the evidence supporting its use is still unknown. Therefore, we aimed to conduct a systematic review, meta-analysis and quality assessment of GONB local anaesthetics combined or not with corticosteroids to prevent CM. METHODS We searched Medline, Scopus and Web of Science up to October 2020. We included randomized control trials (RCT) and observational studies assessing GONB without language restrictions. Two researchers selected the studies, extracted the data and evaluated the risk of bias independently. The primary outcomes measured to assess efficacy were the change from baseline in the intensity and frequency of headache in the intervention group compared to placebo at a onetime point. We performed a meta-analysis with random effect models, and we evaluated random errors with trial sequential analysis (TSA). We assessed the risk of bias (ROB) with the ROB2 tool and the certainty of the evidence with GRADE. RESULTS We identified 2864 studies in the databases and included three RCTs for quantitative synthesis. Most ROB assessments were 'high risk' or 'some concerns'. GONB reduced the intensity of headaches at the end of the first month (MD: -1.35, 95% CI: -2.12 to -0.59) and the second month (MD: -2.10, CI 95%: -2.94 to -1.26) as well as the frequency of headaches (first month: MD: -4.45 days, 95% CI: -6.56 to -2.34 days; second month: MD: -5.49, 95% CI -8.94 to -2.03 days). Corticosteroids did not show a significant decrease in the frequency of headaches during the first month of treatment (MD: -1.1 days, 95% CI: -4.1 to 1.8, p = .45). Included trials reported similar adverse events between groups. The exploratory TSA showed inconclusive results. Overall, the quality of the evidence was very low because of the substantial risk of bias and imprecision. CONCLUSION The limited evidence available shows that GONB with local anaesthetics could reduce headache frequency and intensity compared to placebo, while adding corticosteroids did not show additional benefits. GONB was safe with a similar number of minor adverse events. However, our confidence in these estimates is very low since the evidence is based on a few trials, with a small sample size and a significant risk of bias. In addition, the exploratory TSA was inconclusive, so we need larger and specific trials.
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Affiliation(s)
- Victor Velásquez-Rimachi
- Red de Eficacia Clínica y Sanitaria, Lima, Peru.,Grupo de Investigación en Neurociencia, Efectividad Clínica y Salud Pública, Universidad Científica del Sur, Lima, Peru.,Servicio de Neurología, Departamento de Medicina y Oficina de Apoyo a la Docencia e Investigación (OADI), Hospital Daniel Alcides Carrión, Callao, Peru
| | - Jorge Chachaima-Mar
- Red de Eficacia Clínica y Sanitaria, Lima, Peru.,Servicio de Neurología, Departamento de Medicina y Oficina de Apoyo a la Docencia e Investigación (OADI), Hospital Daniel Alcides Carrión, Callao, Peru.,Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | | | - Cristian Morán-Mariños
- Red de Eficacia Clínica y Sanitaria, Lima, Peru.,Servicio de Neurología, Departamento de Medicina y Oficina de Apoyo a la Docencia e Investigación (OADI), Hospital Daniel Alcides Carrión, Callao, Peru.,Unidad de Investigación en Bibliometría, Universidad San Ignacio de Loyola, Lima, Peru
| | - Kevin Pacheco-Barrios
- Unidad de Investigación Para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru.,Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Margarita Posso
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Carlos Alva-Díaz
- Grupo de Investigación en Neurociencia, Efectividad Clínica y Salud Pública, Universidad Científica del Sur, Lima, Peru.,Servicio de Neurología, Departamento de Medicina y Oficina de Apoyo a la Docencia e Investigación (OADI), Hospital Daniel Alcides Carrión, Callao, Peru.,Universidad Científica del Sur, Facultad de Ciencias de la Salud, Lima, Peru
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Love SM, Hopkins BD, Migdal CW, Schuster NM. Occipital headache evaluation and rates of migraine assessment, diagnosis, and treatment in patients receiving greater occipital nerve blocks in an academic pain clinic. PAIN MEDICINE 2022; 23:1851-1857. [PMID: 35595240 DOI: 10.1093/pm/pnac080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 05/13/2022] [Accepted: 05/15/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Diagnosis of patients with occipital headache can be challenging, as both primary and secondary causes must be considered. Our study assessed how often migraine is screened for, diagnosed, and treated in patients receiving greater occipital nerve blocks (GONBs) in a pain clinic. DESIGN IRB-approved, retrospective observational study. SETTING Academic multidisciplinary pain clinic. SUBJECTS 143 consecutive patients who received GONBs. RESULTS About 75% of patients had been evaluated by neurologists and about 25% by non-neurologist pain specialists only. 62.2% of patients had photophobia, phonophobia, and nausea assessed. Patients who had been evaluated by a neurologist were more likely to have photophobia, phonophobia, and nausea assessed (75.9% vs 20.0%, OR 12.6, 95% CI 4.90-32.2), more likely to be diagnosed with migraine (48.1% vs 14.3%, OR 5.6, 95% CI 2.0-15), less likely to be diagnosed with occipital neuralgia (39.8% vs 65.7%, OR 0.3, 95% CI 0.2-0.8), and equally likely to be diagnosed with cervicogenic headache (21.3% vs 25.7%, OR 0.8, 95% CI 0.3-1.9) than those evaluated by non-neurologists. Among patients diagnosed with migraine, 82.5% received acute migraine treatment, 89.5% received preventive migraine treatment, and 52.6% were documented as receiving migraine lifestyle counseling. CONCLUSIONS 62.2% of patients with occipital headache receiving GONBs were assessed for migraine, and most received appropriate acute, preventive, and lifestyle treatments when diagnosed. Patients seen by neurologists were significantly more likely to be screened for, and diagnosed with, migraine than those evaluated by non-neurologist pain medicine specialists only. All clinicians should remain vigilant for migraine in patients with occipital headache.
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Affiliation(s)
- Shawn M Love
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA
| | | | | | - Nathaniel M Schuster
- Center for Pain Medicine, Department of Anesthesiology, University of California, San Diego, San Diego, CA
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Yang S, Exposto FG, Mahmoodi S, Svensson P. Mechanical sensitivity changes in pericranial muscles after local anesthesia and experimentally induced pain in the temporalis tendon: Implications for headache and facial pain. Cephalalgia 2022; 42:1127-1137. [PMID: 35469481 DOI: 10.1177/03331024221094294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To assess changes in mechanical sensitivity of the pericranial muscles in healthy individuals after a local anesthetic block of the temporalis tendon. In addition, to assess, if experimentally induced temporalis tendon pain, can lead to an increase in mechanical sensitivity of the pericranial muscles and reports of headache. METHODS 40 healthy participants were recruited for this randomized, double-blinded, controlled experiment, and were randomly injected with mepivacaine and isotonic saline into the dominant-side temporalis tendon in two different sessions, and either nerve growth factor (n = 20) or isotonic saline (n = 20) in a third session. Mechanical sensitivity was assessed in the temporalis, masseter, and trapezius muscles as well as in the temporalis tendon, on the dominant side, before and 10 minutes after each injection, and in a fourth session two days after the third session. Pain drawings and headache diaries were kept for 30 days after the final session to register any developing pain or headache. RESULTS Mepivacaine injection into the temporalis tendon caused a significant decrease in mechanical sensitivity in the temporal tendon (-54.5%) and the masseter (-15.4%) muscle (P < 0.05) but not the temporalis (-12.1%) and trapezius muscles (-12.7%) (P > 0.05). Nerve growth factor injection into the temporalis tendon caused a significant increase in mechanical sensitivity in the tendon (+15.4%) and masseter muscle (+14.4%) (P < 0.05) but not the temporalis (+2.8%) or trapezius muscles (+3.1%) (P > 0.05). A significant increase was found for headache frequency in the first seven days (P < 0.05) after nerve growth factor injection compared to after isotonic saline injection, but not intensity (P > 0.05). CONCLUSION These findings suggest that the therapeutic effect of temporalis tendon anesthetic injections on facial pain and headaches are most likely not only due to a direct effect of the local anesthetic on the temporalis tendon but rather to a more generalized block of the nerves in the area. In addition, the temporal tendon may contribute to the pathophysiological processes of headache.
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Affiliation(s)
- Shuting Yang
- Section for Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Health, Aarhus University, Aarhus, Denmark.,Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark
| | - Fernando G Exposto
- Section for Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Health, Aarhus University, Aarhus, Denmark.,Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark
| | | | - Peter Svensson
- Section for Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Health, Aarhus University, Aarhus, Denmark.,Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark.,Faculty of Odontology, Malmö University, Sweden
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Abstract
PURPOSE OF REVIEW This manuscript aims to review the risks and the current treatments for postdural puncture headache (PDPH). RECENT FINDINGS PDPH is a relatively frequent complication after neuraxial blocks. It is typically orthostatic in nature, presenting as a positional and dull aching or throbbing headache, with added dysregulation of auditory and/or visual signals. Certain characteristics, such as female sex and young age, may predispose patients to the development of PDPH, as may factors such as previous PDPH, bearing down during the second stage of labor, and the neuraxial technique itself. Long-term complications including chronic headache for years following dural puncture have brought into question of the historical classification of PDPH as a self-limiting headache. So far, the underlying mechanism governing PDPH remains under investigation, while a wide variety of prophylactic and therapeutic measures have been explored with various degree of success. In case of mild PDPH, conservative management involving bed rest and pharmacological management should be used as first-line treatment. Nerve blocks are highly efficient alternatives for PDPH patients who do not respond well to conservative treatment. In case of moderate-to-severe PDPH, epidural blood patch remains the therapy of choice. An interdisciplinary approach to care for patients with PDPH is recommended to achieve optimal outcomes.
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Karacan Gölen M, Yılmaz Okuyan D. Comparison of the Effectiveness of Greater Occipital Nerve Block in Patients Receiving and not Receiving Medical Prophylactic Treatment in Chronic Migraine. TURKISH JOURNAL OF NEUROLOGY 2022. [DOI: 10.4274/tnd.2021.29660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Impact of Greater Occipital Nerve Block on Photophobia Levels in Migraine Patients. J Neuroophthalmol 2022; 42:378-383. [PMID: 35421036 DOI: 10.1097/wno.0000000000001541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND To study the effect of greater occipital nerve (GON) block on migraine-associated photophobia levels. Photophobia is one of the most bothersome symptoms reported by migraine patients. Studies investigating the impact of migraine treatment on this symptom are scarce. METHODS This is an observational prospective case-control study. Patients with migraine and photophobia attending a Headache Clinic were recruited. Cases were defined as patients in whom GON block was performed, following usual clinical practice guidelines. All patients were evaluated with the Hospital Anxiety and Depression Scale, the Migraine Specific Quality of Life Questionnaire, the Utah Photophobia Symptom Impact Scale (UPSIS-12), and the Korean Photophobia Questionnaire (KUMC-8); both in the first visit (V1) and one week after (V2). RESULTS Forty-one patients were recruited, 28 (68.3%) cases and 13 (31.7%) controls. At V1, there were no significant differences in the median [p25-p75] score of UPSIS-12 in cases vs controls (32.0 [21.0-34.0] vs 30.5 [22.0-37.0], P = 0.497) or KUMC-8 (6.5 [5.5-7.0] vs 7.0 [6.0-8.0], P = 0.463). At V2, cases experimented a significant improvement in UPSIS-12 of -5.5 [-8.8 to -1.3] and in KUMC-8 of -0.5 [-2.0 to 0], whereas there were no significant changes in the control group. Migraine with aura patients presented higher UPSIS-12 score at V1 (33.5 [24.5-37.0] vs 26.0 [16.0-35.0]) and lesser improvement at V2 after GON block compared with migraine without aura patients (-4.0 [-6.0 to -1.0] vs -8.0 [-17.0 to -2.0]), although statistical significance was not achieved (P = 0.643 and P = 0.122, respectively). There was no significant variation in the remaining scales. CONCLUSIONS Greater occipital nerve block improves migraine-associated photophobia, measured with UPSIS-12 and KUMC-8. Patients without aura may exhibit a greater improvement. Physicians could consider GON block for management of photophobia in migraine patients.
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Karaoğlan M, İnan LE. A Comparison of The Clinical Efficacy of GON Block at The C2 Level and GON Block at The Classical Distal Occipital Level in The Treatment of Migraine. Clin Neurol Neurosurg 2022; 215:107190. [DOI: 10.1016/j.clineuro.2022.107190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/01/2022] [Accepted: 02/27/2022] [Indexed: 11/30/2022]
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Hoffmann J, Mehnert J, Koo EM, May A. Greater occipital nerve block modulates nociceptive signals within the trigeminocervical complex. J Neurol Neurosurg Psychiatry 2021; 92:1335-1340. [PMID: 34312221 DOI: 10.1136/jnnp-2021-326433] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 06/28/2021] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The pharmacological block of the greater occipital nerve has been proven effective in numerous headache and facial pain syndromes. This clinical effect supports the hypothesis of a strong functional interaction between the occipital and trigeminal nerves which has been proposed in neurophysiological in vivo experiments in rodents. Although it is likely that the interaction has to occur in the central nervous system, the exact site and the mechanisms of the interaction remain largely unknown. METHODS Focusing on these questions we investigated in a double-blind, placebo-controlled, randomised study the influence of an occipital nerve block with lidocaine 1% on neuronal activation in the trigeminocervical complex using high-resolution functional magnetic resonance on a 3T scanner. In order to investigate potential clinical effects on the trigeminal nerve, we further performed quantitative sensory testing and analysed a potential shift in thermal detection and pain thresholds. RESULTS The pharmacological block of the greater occipital nerve induced an occipital anaesthesia ipsilateral to the block. Functional imaging revealed that the occipital injection of lidocaine but not placebo significantly reduced nociceptive trigeminal activation. CONCLUSIONS These data suggest that the functional inhibition of the occipital nerve block on trigeminal nociceptive activity is likely to occur at the C2 level where the occipital nerve enters the trigeminocervical complex and converges on the same central nuclei before the signal crosses the midline at that level and is then transmitted to higher processing centres.
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Affiliation(s)
- Jan Hoffmann
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Wolfson Centre for Age-Related Diseases, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jan Mehnert
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Elena M Koo
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Arne May
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Malekian N, Bastani PB, Oveisgharan S, Nabaei G, Abdi S. Preventive effect of greater occipital nerve block on patients with episodic migraine: A randomized double-blind placebo-controlled clinical trial. Cephalalgia 2021; 42:481-489. [PMID: 34786992 DOI: 10.1177/03331024211058182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Since the data regarding the efficacy of greater occipital in episodic migraines are rare, we aimed to examine the efficacy of greater occipital block in the prophylaxis of episodic migraines without aura and compare different injectable drug regimens. METHODS In a randomized, double-blind placebo-controlled trial, adult patients suffering from episodic migraines without aura were randomized to one of the following: triamcinolone, lidocaine, triamcinolone plus lidocaine, and saline. Patients were assessed at baseline, one week, two weeks, and four weeks after the injection for severity and duration of headaches and side effects. RESULTS Fifty-five patients completed the study. Repeated measures ANOVA indicated that the severity and duration decreased significantly after the greater occipital block (P < 0.001, P = 0.001 respectively) in all four groups. However, there was no difference between groups at any study time points (P > 0.05). In paired sample T-test, only groups 2 and 3 with lidocaine as a part of the injection showed a significant decrease in frequency compared to the baseline (P = 0.002, P = 0.019). Three patients reported side effects with a possible association with triamcinolone. CONCLUSION Greater occipital block with a local anesthetic significantly decreases the number of attacks in episodic migraine, whereas no injection was superior to the placebo in regards to the duration and severity of the headaches.Trial Registration Information: Iranian Registry of Clinical Trials (IRCT). Registration number: IRCT2017070334879N1. https://www.irct.ir/trial/26537.
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Affiliation(s)
- Nazila Malekian
- Neurology Department, 48439Tehran University of Medical Sciences, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Pouya B Bastani
- Neurology Department, 48439Tehran University of Medical Sciences, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahram Oveisgharan
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Ghaemeh Nabaei
- Neurology Department, 48439Tehran University of Medical Sciences, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Siamak Abdi
- The Iranian Center of Neurological Research, 48439Tehran University of Medical Sciences, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
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Effects of cranial nerve blockage in patients with chronic migraine resistant to first-line treatment. JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.1000962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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The Efficacy of Greater Occipital Nerve Block in Patients With Chronic Migraine. JOURNAL OF CONTEMPORARY MEDICINE 2021. [DOI: 10.16899/jcm.955017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Barad M, Ailani J, Hakim SM, Kissoon NR, Schuster NM. Percutaneous Interventional Strategies for Migraine Prevention: A Systematic Review and Practice Guideline. PAIN MEDICINE 2021; 23:164-188. [PMID: 34382092 DOI: 10.1093/pm/pnab236] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To systematically evaluate the efficacy and effectiveness of percutaneous interventional treatments for prevention of migraine through a qualitative and (when possible) quantitative analysis. METHODS An expert panel was asked to develop recommendations for the multidisciplinary preventive treatment of migraine, including interventional strategies. The committee conducted a systematic review and (when evidence was sufficient) a meta-analytic review using GRADE criteria and the modified Cochrane risk of bias analysis available in the Covidence data management program. Clinical questions addressed adults with migraine who should be offered prevention. Examined outcomes included headache days, acute medication use, and functional impairment. Acute management of migraine was outside the scope of this guideline. RESULTS The committee screened 1195 studies and assessed 352 by full text, yielding 16 randomized controlled trials that met inclusion criteria. RECOMMENDATIONS/CONCLUSIONS As informed by evidence related to the preselected outcomes, adverse event profile, cost, and values and preferences of patients, onabotulinumtoxinA received a strong recommendation for chronic migraine prevention and a weak recommendation against use for episodic migraine prevention. Greater occipital nerve blocks received a weak recommendation for chronic migraine prevention. For greater occipital nerve block, steroid received a weak recommendation against use vs local anesthetic alone. Occipital nerve with supraorbital nerve blocks, sphenopalatine ganglion blocks, cervical spine percutaneous interventions, and implantable stimulation all received weak recommendations for chronic migraine prevention. The committee found insufficient evidence to assess trigger point injections in migraine prevention and highly discouraged use of intrathecal medication.
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Affiliation(s)
- Meredith Barad
- Anesthesia (Pain Management) and Neurology and Neurological Sciences, Stanford Hospital and Clinics, Stanford, California, USA
| | - Jessica Ailani
- Neurology, Medstar Georgetown University, Washington, DC, USA
| | - Sameh M Hakim
- Anesthesiology, Intensive Care, and Pain Management, Ain Shams University Faculty of Medicine, Cairo, Egypt
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Robbins MS. Clinic-based Procedures for Headache. ACTA ACUST UNITED AC 2021; 27:732-745. [PMID: 34048401 DOI: 10.1212/con.0000000000000959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW Headache disorders are common and disabling, and many therapies that are effective and safe are procedural. RECENT FINDINGS After pivotal clinical trials, onabotulinumtoxinA has become an established preventive therapy for chronic migraine; it is better tolerated than many other treatments and may be useful for other headache disorders. Peripheral nerve blocks, especially greater occipital nerve blocks, have amassed evidence from randomized trials in the acute and short-term preventive treatment of migraine and cluster headache. Trigger point injections and sphenopalatine ganglion blocks have recent trials suggesting efficacy and safety in properly selected patients. Medical education initiatives are needed to train neurologists in these procedures to help manage the large population of patients with headache disorders who need them. SUMMARY Evidence exists for the efficacy and safety of procedural therapies to be incorporated into neurology practice for the management of patients with migraine, cluster headache, and other headache disorders.
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Effectiveness of greater occipital nerve blocks in chronic migraine. JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.911665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Carvalho GF, Luedtke K, Szikszay TM, Bevilaqua-Grossi D, May A. Muscle endurance training of the neck triggers migraine attacks. Cephalalgia 2020; 41:383-391. [PMID: 33200945 DOI: 10.1177/0333102420970184] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Most migraine patients report neck pain as part of their migraine symptomatology, but it is unknown whether triggering neck pain would induce migraine attacks. Our aim was to assess the occurrence of headache and/or neck pain after an endurance test of the neck muscles among migraineurs and controls. METHODS Sixty-five patients with migraine and 32 headache-free participants underwent a manual examination of the cervical spine by an assessor blinded towards the diagnosis and were sub-classified according to the appearance or absence of neck pain. Subsequently, the endurance of the neck flexors and extensors was tested three times, in a random order. The maximum sustained duration was recorded and the test was terminated when the subject was unable to maintain the position or reported pain. On the day after the assessment, participants were asked to report the potential occurrence of headache or neck symptoms. RESULTS None of the controls reported headache after assessment, while migraine-like headache was reported by 42% of the patients with migraine (p < 0.001) after 15.8 h (SD: 10.0). Neck pain was more prevalent in migraineurs compared to controls (45% vs. 16%, p = 0.006). When considering the neck pain subtype, there were no differences among the three profiles regarding neck pain but participants with referred pain to the head reported a migraine attack more often (45%, p = 0.03). CONCLUSION Patients with migraine are more likely to report neck pain and migraine attacks following a neck muscle endurance test. Participants with neck pain referred to the head during manual examination had a greater prevalence of migraine attacks than those without or with only local pain.
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Affiliation(s)
- Gabriela F Carvalho
- Department of Systems Neuroscience, University of Hamburg-Eppendorf, Hamburg, Germany.,Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.,Institute of Health Sciences, Academic Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), University of Luebeck, Luebeck, Germany
| | - Kerstin Luedtke
- Department of Systems Neuroscience, University of Hamburg-Eppendorf, Hamburg, Germany.,Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Tibor M Szikszay
- Department of Systems Neuroscience, University of Hamburg-Eppendorf, Hamburg, Germany.,Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Debora Bevilaqua-Grossi
- Institute of Health Sciences, Academic Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), University of Luebeck, Luebeck, Germany
| | - Arne May
- Department of Systems Neuroscience, University of Hamburg-Eppendorf, Hamburg, Germany
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Chiou JY, Abd-Elrehim T, Lin CC, Chen GS. Feasibility study of greater occipital nerve blocks by focused ultrasound - an animal study. J Neural Eng 2020; 17:056030. [PMID: 33146147 DOI: 10.1088/1741-2552/abb14d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Greater occipital nerve (GON) block may provide substantial relief for headache in the occipital location. This study tested the feasibility of focused ultrasound (FUS) to induce the conduction block of GONs in rats. APPROACH For in vitro experiments, the nerve was dissected and cut from C2 to the site near the ear of the rats and preserved in Ringer's solution. Pulsed FUS was used for the block, and sensory action potentials were recorded in the GON. For in vivo experiments, the GONs of the rats were surgically exposed for precise ultrasonic treatment. All data are expressed as the mean ± the standard deviation. MAIN RESULTS A single ultrasonic treatment temporarily suppressed the amplitude of action potentials of the in vitro nerves to 42 ± 14% of the baseline values, and the time to recovery was 55 min. The in vivo results showed that FUS acutely inhibited the amplitude of action potentials to 41 ± 8% of the baseline value in rat GONs, and the time to recovery was 67 min. Histological examination revealed no appreciable changes in the nerve morphology caused by FUS. Therefore, FUS reversibly blocked the conduction of the rat GON when the sonication parameters were appropriate. SIGNIFICANCE Noninvasive FUS may be a novel treatment paradigm for occipital headache by blocking the occipital nerve, and the procedure is repeatable if indicated.
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Affiliation(s)
- Jiun-Yi Chiou
- Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, Zhunan, Taiwan
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Chowdhury D, Mundra A. Role of greater occipital nerve block for preventive treatment of chronic migraine: A critical review. CEPHALALGIA REPORTS 2020. [DOI: 10.1177/2515816320964401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective:The aim of this study is to critically analyze the evidence of the efficacy and safety of greater occipital nerve (GON) block for the preventive treatment of chronic migraine (CM).Background:A rigorous scientific assessment of efficacy and safety of the GON block for preventive treatment in CM is not available. This critical review was undertaken for this purpose.Methods:References for this review were identified by searches of articles published in the English language in PubMed between 1969 and April 15, 2020 using “greater occipital nerve block,” “chronic migraine,” “migraine,” “headache,” and “treatment” as keywords.Results:Out of potential 532 articles, 9 open-label and 4 placebo-controlled trials that studied the role of GON block for prevention of CM were identified and reviewed. Open-label trials reported a reduction of headache severity and frequency in 35–68% of patients. The beneficial effect of a single block lasted up to 4 weeks. Randomized controlled trials (RCTs) used varied methodology and techniques of GON block and the outcomes were reported at different time points. A single RCT showed a beneficial effect of the GON block at 1 week. However, the GON block was found to be safe and well tolerated.Conclusion:Long-term efficacy of GON block in CM shall need further well-designed RCTs using standardized methodology. This study, in addition, reviewed the limitations and uncertainties regarding the technique and methods of use of GON block in CM.
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Affiliation(s)
- Debashish Chowdhury
- Department of Neurology, GB Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - Ankit Mundra
- Department of Neurology, GB Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
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Ricquart Wandaele A, Kastler A, Comte A, Hadjidekov G, Kechidi R, Helenon O, Kastler B. CT-guided infiltration of greater occipital nerve for refractory craniofacial pain syndromes other than occipital neuralgia. Diagn Interv Imaging 2020; 101:643-648. [DOI: 10.1016/j.diii.2020.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/23/2020] [Accepted: 05/05/2020] [Indexed: 12/30/2022]
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Schwarz A, Ziegeler C, Daneshkhah S, May A, Luedtke K. Predicting the outcome of the greater occipital nerve block - an observational study on migraine patients with and without musculoskeletal cervical impairment. Cephalalgia 2020; 41:78-89. [PMID: 32867534 DOI: 10.1177/0333102420954518] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVE The importance of neck pain and the trigeminocervical complex in migraine is of high pathophysiological interest since a block to the greater occipital nerve is more effective for some primary headaches than others. This observational study hypothesised that the response to manual palpation of the upper cervical spine predicts the efficacy of the greater occipital nerve-block. METHODS We divided patients, scheduled by a neurologist to receive a greater occipital nerve-block to reduce their migraine symptoms, into three groups: Patients with no pain response to manual palpation of the neck, patients with local pain, and those with referred pain to the head. Primary outcome was the percentage change in headache frequency. Additionally, items from the quantitative sensory testing protocol were included. RESULTS Eighty-seven chronic migraine patients were recruited consecutively from a specialised outpatient clinic and 71 were included for analyses and stratified into the three groups: No pain (n = 11), local pain (n = 28), and referred pain to the head (n = 32). Overall, patients experienced a reduction of 1.9 headache days per month (SD 3.4, p < 0,0001). The groups differed significantly in the percentage change of headache frequency (p = 0.041) with the "no pain" group showing the largest reduction. The pressure-pain-threshold over C2 and headache on the day of the intervention influenced the outcome significantly (R2 0,27, p = 0,00078). No serious adverse events occurred. Sixty-five percent of the patients had headaches during the examination. The groups did not differ regarding the distribution of patients with neck-pain in absence of migraine at baseline (p = 0.618). CONCLUSION Patients that were less sensitive to palpation in the cervical region and headache-free on the day of the intervention improved more after the greater occipital nerve-block.Registration: Registered a priori at the German Clinical Trials Register (DRKS00015995).
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Affiliation(s)
- Annika Schwarz
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Health Sciences, Academic Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L), University of Luebeck, Luebeck, Germany
| | - Christian Ziegeler
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sima Daneshkhah
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Arne May
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kerstin Luedtke
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Health Sciences, Academic Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L), University of Luebeck, Luebeck, Germany
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Ulusoy EK, Bolattürk ÖF. The effect of greater occipital nerve blockade on the quality of life, disability and comorbid depression, anxiety, and sleep disturbance in patients with chronic migraine. Neurol Sci 2020; 41:1829-1835. [PMID: 32056056 DOI: 10.1007/s10072-020-04286-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 02/09/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The greater occipital nerve block (GONB) with local anesthetics is an effective treatment for chronic migraine (CM). In this study, it was aimed to demonstrate the change in quality of life, depression, anxiety, and sleep disturbance scores before and after treatment in CM patients who underwent GONB and the effectiveness of treatment. PATIENTS AND METHODS The study included 84 patients diagnosed as CM according to the International Classification of Headache Disorders III beta version diagnostic criteria. The 24-Hour Migraine Quality of Life Questionnaire (MQoLQ), Migraine Disability Assessment Scale (MIDAS), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Pittsburgh Sleep Quality Index (PSQI), Headache Impact Test (HIT), and Visual Analog Scale (VAS) were applied on patients before GONB treatment and at posttreatment months 1 and 3. RESULTS MQoLQ scores, which measured the daily quality of life, were 38 [3-66] before GONB treatment, and 64 [38-88] in the first month and 72 [40-86] in the third month after treatment. In addition, this increase was statistically significant (p < 0.001). Furthermore, we found a statistically significant decrease in disability, depression, anxiety, and sleep disturbance scores after treatment (p < 0.05). CONCLUSION In this study, we observed a prominent improvement in quality of life and disability rates of CM patients treated with GONB compared to pretreatment. We also demonstrated that the treatment was effective in comorbid depression, anxiety, and sleep disturbance scores.
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Affiliation(s)
- Ersin Kasım Ulusoy
- Neurology Department, Kayseri Training and Research Hospital, Şeker Mahallesi, Molu Yolu/Kocasinan, 38010, Kayseri, Turkey.
| | - Ömer Faruk Bolattürk
- Neurology Department, Kayseri Training and Research Hospital, Şeker Mahallesi, Molu Yolu/Kocasinan, 38010, Kayseri, Turkey
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Mathew PG, Najib U, Khaled S, Krel R. Prevalence of Occipital Neuralgia at a Community Hospital-based Headache Clinic. Neurol Clin Pract 2019; 11:6-12. [PMID: 33968466 DOI: 10.1212/cpj.0000000000000789] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 10/15/2019] [Indexed: 12/25/2022]
Abstract
Background Occipital neuralgia (ON) is a paroxysmal disorder involving lancinating pain that originates in the neck or skull base with superior radiation toward the apex. ON more commonly occurs in patients with other coexisting headache disorders. There are limited data regarding the prevalence of ON. This study aims to demonstrate the prevalence of ON in a community hospital-based headache clinic. Methods This IRB-approved retrospective study was conducted at the Cambridge Health Alliance Headache Clinic. Medical records of patients presenting with headache as a chief complaint were reviewed from January 2010 to September 2015. Results Of 800 study patients, 81% were females (n = 648). A total of 195 patients were diagnosed with ON, and 146 patients had a positive occipital Tinel sign on examination. Isolated ON was present in 15.38% (n = 30) of patients. Multiple regression analysis demonstrated that the odds of ON were higher in patients with chronic migraine vs episodic migraine (adjusted odds ratio = 2.190 [95% confidence interval: 1.364-3.515]), even when adjusted for significant covariates. Conclusion ON occurred in nearly 25% of patients presenting with a chief complaint of headache to a community hospital-based headache clinic. Among patients with ON, 15% presented with ON as the chief complaint without another coexisting headache disorder. As such, up to 85% of ON cases occurred in patients having an additional headache type. Approximately 75% of patients with ON had a positive occipital Tinel sign on examination. Elevated body mass index, higher age at presentation, and chronic migraine increased the odds of having ON. Undiagnosed or inadequate treatment of ON can increase the frequency and intensity of other comorbid headache disorders.
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Affiliation(s)
- Paul G Mathew
- Department of Neurology (PGM), Brigham and Women's Hospital, Boston; Department of Neurology (PGM), Harvard Vanguard Medical Associates, Braintree; Division of Neurology (PGM), Cambridge Health Alliance; Harvard Medical School (PGM), Boston, MA; Department of Neurology (UN), West Virginia University, School of Medicine, Morgantown, WV; St. George's University (SK), School of Medicine, Grenada, WI; Hackensack Meridian School of Medicine at Seton Hall University (RK), Nutley; and Neuroscience Institute at Hackensack University Medical Center (RK), Hackensack, NJ
| | - Umer Najib
- Department of Neurology (PGM), Brigham and Women's Hospital, Boston; Department of Neurology (PGM), Harvard Vanguard Medical Associates, Braintree; Division of Neurology (PGM), Cambridge Health Alliance; Harvard Medical School (PGM), Boston, MA; Department of Neurology (UN), West Virginia University, School of Medicine, Morgantown, WV; St. George's University (SK), School of Medicine, Grenada, WI; Hackensack Meridian School of Medicine at Seton Hall University (RK), Nutley; and Neuroscience Institute at Hackensack University Medical Center (RK), Hackensack, NJ
| | - Shaoleen Khaled
- Department of Neurology (PGM), Brigham and Women's Hospital, Boston; Department of Neurology (PGM), Harvard Vanguard Medical Associates, Braintree; Division of Neurology (PGM), Cambridge Health Alliance; Harvard Medical School (PGM), Boston, MA; Department of Neurology (UN), West Virginia University, School of Medicine, Morgantown, WV; St. George's University (SK), School of Medicine, Grenada, WI; Hackensack Meridian School of Medicine at Seton Hall University (RK), Nutley; and Neuroscience Institute at Hackensack University Medical Center (RK), Hackensack, NJ
| | - Regina Krel
- Department of Neurology (PGM), Brigham and Women's Hospital, Boston; Department of Neurology (PGM), Harvard Vanguard Medical Associates, Braintree; Division of Neurology (PGM), Cambridge Health Alliance; Harvard Medical School (PGM), Boston, MA; Department of Neurology (UN), West Virginia University, School of Medicine, Morgantown, WV; St. George's University (SK), School of Medicine, Grenada, WI; Hackensack Meridian School of Medicine at Seton Hall University (RK), Nutley; and Neuroscience Institute at Hackensack University Medical Center (RK), Hackensack, NJ
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Great Occipital Nerve as Donor Nerve for Neurotization With Suprascapular Nerve in Total Braqchial Plexus Injuries: Nerve Transfer Technique. Tech Hand Up Extrem Surg 2019; 24:98-101. [PMID: 31764485 DOI: 10.1097/bth.0000000000000274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Complete brachial plexus injuries continue to be a technical and strategic challenge in surgical reconstruction to restore function and sensitivity in a paralyzed and insensitive limb. The use of donor's nerves to perform neurotizations is limited, and, in reconstructions for preganglionic lesions, these techniques have gained prominence, even leaving comorbidities in the donor sites. The purpose of this paper is to present the great suboccipital nerve as a new donor nerve bases on our anatomic research with the transfer technique from the great occipital nerve to the suprascapular nerve.
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Shauly O, Gould DJ, Patel KM. Cost-Utility Analysis of Surgical Decompression Relative to Injection Therapy for Chronic Migraine Headaches. Aesthet Surg J 2019; 39:NP462-NP470. [PMID: 30868158 DOI: 10.1093/asj/sjz069] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Common treatments for chronic migraine headaches include injection of corticosteroid and anesthetic agents at local trigger sites. However, the effects of therapy are short term, and lifelong treatment is often necessary. In contrast, surgical decompression of migraine trigger sites accomplishes the same goal yet demonstrates successful long-term elimination of chronic migraines. OBJECTIVES Our primary objective was to perform a cost-utility analysis to determine which patients would benefit most from available treatment options in a cost-conscious model. METHODS A cost-utility analysis was performed, taking into consideration costs, probabilities, and health state utility scores of various interventions. RESULTS Injection therapy offered a minor improvement in quality-adjusted life-years (QALYs) compared with surgical decompression (QALY Δ = 0.6). However, long-term injection therapy was significantly costlier to society than surgical decompression: injection treatment was estimated to cost $106,887.96 more than surgery. The results of our cost-utility analysis thus conferred a positive incremental cost-utility ratio of $178,163.27 in favor of surgical decompression. CONCLUSIONS Surgery provides a durable intervention and has been shown in this study to be extremely cost effective despite a very minor QALY deficit compared with injection therapy. If patients are identified who require treatment in the form of injections for less than 8.25 years, they may fall into a group that should not be offered surgery.
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Affiliation(s)
- Orr Shauly
- Department of Plastic and Reconstructive Surgery, Keck Hospital of USC, Los Angeles, CA
| | - Daniel J Gould
- Department of Plastic and Reconstructive Surgery, Keck Hospital of USC, Los Angeles, CA
| | - Ketan M Patel
- Department of Plastic and Reconstructive Surgery, Keck Hospital of USC, Los Angeles, CA
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Amirlak B, Chung MH, Masrour S. Commentary on: Cost-Utility Analysis of Surgical Decompression Relative to Injection Therapy for Chronic Migraine Headaches. Aesthet Surg J 2019; 39:NP471-NP473. [PMID: 31504133 DOI: 10.1093/asj/sjz198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Bardia Amirlak
- Department of Plastic Surgery and Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX
| | - Michael H Chung
- Department of Plastic Surgery and Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX
| | - Shamin Masrour
- Department of Plastic Surgery and Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX
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Weatherall MW, Nandi D. Percutaneous electrical nerve stimulation (PENS) therapy for refractory primary headache disorders: a pilot study. Br J Neurosurg 2019; 33:608-612. [DOI: 10.1080/02688697.2019.1671951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
| | - Dipankar Nandi
- Department of Neurosurgery, Charing Cross Hospital, Imperial College NHS Healthcare, London, UK
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Greater Occipital Nerve Block for the Treatment of Chronic Migraine Headaches: A Systematic Review and Meta-Analysis. Plast Reconstr Surg 2019; 144:943-952. [PMID: 31568309 DOI: 10.1097/prs.0000000000006059] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Few treatment options exist for chronic migraine headaches, with peripheral nerve blocks having long been used to reduce the frequency and severity of migraines. Although the therapeutic effects have been observed in clinical practice, the efficacy has never been fully studied. In the past decade, however, several randomized controlled clinical trials have been conducted to assess the efficacy of greater occipital nerve block in the treatment of chronic migraine headaches. METHODS A systematic review of the literature was performed in the citation databases PubMed, Embase, MEDLINE, and the Cochrane Library. The initial search of databases yielded 259 citations, of which 33 were selected as candidates for full-text review. Of these, nine studies were selected for inclusion in this meta-analysis. RESULTS Studies were analyzed that reported mean number of headache days per month in both intervention and control groups. A total of 417 patients were studied, with a pooled mean difference of -3.6 headache days (95 percent CI, -1.39 to -5.81 days). This demonstrates that greater occipital nerve block intervention significantly reduced the frequency of migraine headaches compared with controls (p < 0.00001). Pooled mean difference in pain scores of -2.2 (95 percent CI, -1.56 to -2.84) also demonstrated a significant decrease in headache severity compared with controls (p < 0.0121). CONCLUSIONS Greater occipital nerve blocking should be recommended for use in migraine patients, particularly those that may require future surgical intervention. The block may act as an important stepping stone for patients experiencing migraine headache because of its usefulness for potentially assessing surgical candidates for nerve decompression. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
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Discussion: Greater Occipital Nerve Block for the Treatment of Chronic Migraine Headaches: A Systematic Review and Meta-Analysis. Plast Reconstr Surg 2019; 144:953-955. [PMID: 31568310 DOI: 10.1097/prs.0000000000006060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Tajti J, Szok D, Nyári A, Vécsei L. Therapeutic strategies that act on the peripheral nervous system in primary headache disorders. Expert Rev Neurother 2019; 19:509-533. [DOI: 10.1080/14737175.2019.1615447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- János Tajti
- Department of Neurology, Faculty of Medicine, Interdisciplinary Excellence Centre, University of Szeged, Szeged, Hungary
| | - Délia Szok
- Department of Neurology, Faculty of Medicine, Interdisciplinary Excellence Centre, University of Szeged, Szeged, Hungary
| | - Aliz Nyári
- Department of Neurology, Faculty of Medicine, Interdisciplinary Excellence Centre, University of Szeged, Szeged, Hungary
| | - László Vécsei
- Department of Neurology, Faculty of Medicine, Interdisciplinary Excellence Centre, University of Szeged, Szeged, Hungary
- MTA-SZTE Neuroscience Research Group of the Hungarian Academy of Sciences, Szeged, Hungary
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Deen M, Martinelli D, Pijpers J, Diener HC, Silberstein S, Ferrari MD, Ashina M, Tassorelli C, Yuan H. Adherence to the 2008 IHS guidelines for controlled trials of drugs for the preventive treatment of chronic migraine in adults. Cephalalgia 2019; 39:1058-1066. [DOI: 10.1177/0333102419847751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Introduction Since the definition of chronic migraine as a new disease entity in 2004, numerous clinical trials have examined the efficacy of preventive treatments in chronic migraine. Our aim was to assess the adherence of these trials to the Guidelines of the International Headache Society published in 2008. Methods We searched PubMed for controlled clinical trials investigating preventive treatment for chronic migraine in adults designed after the release of the Guidelines and published until December 2017. Trial quality was evaluated with a 13-item scoring system enlisting essential recommendations adapted from the Guidelines. Results Out of 3352 retrieved records, we included 16 papers in the analysis dealing with pharmacological treatment of chronic migraine. The median score was 6.5 (range 2–13). All trials were randomized, the large majority (81.25%) were placebo-controlled and double-blinded (87.5%). Adherence was lowest on i) a priori definition of outcomes (31.25%), ii) primary endpoint definition (37.5%%) and iii) trial registration (37.5%). Discussion Most clinical trials adhered to the recommendations of the IHS, whereas adherence to migraine-specific recommendations was lower. Greater awareness and adherence to the guidelines are essential to improve the quality of clinical trials, validity of publications and the generalizability of the results.
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Affiliation(s)
- Marie Deen
- Danish Headache Center, Department of Neurology, Rigshospitalet – Glostrup, Denmark
| | - Daniele Martinelli
- Headache Science Center, IRCCS C. Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Judith Pijpers
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Stephen Silberstein
- Department of Neurology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Michel D Ferrari
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Messoud Ashina
- Danish Headache Center, Department of Neurology, Rigshospitalet – Glostrup, Denmark
| | - Cristina Tassorelli
- Headache Science Center, IRCCS C. Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Hsiangkuo Yuan
- Department of Neurology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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Shauly O, Gould DJ, Patel KM. The Public's Perception of Interventions for Migraine Headache Disorders: A Crowdsourcing Population-Based Study. AESTHETIC SURGERY JOURNAL OPEN FORUM 2019; 1:ojz007. [PMID: 33791603 PMCID: PMC7670936 DOI: 10.1093/asjof/ojz007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Migraine disorders are a leading cause of morbidity and decreased economic productivity
in the United States among both men and women. As such, it is important to consider
patient opinions, and have an accurate representation of the burden and sentiment toward
currently available interventions among those suffering from migraines. Objectives The aim of the study was to assess patient options regarding adverse outcomes of the
various treatment options available for migraine headaches. Methods A prospective cross-sectional study of volunteers recruited through an internet
crowdsourcing service, Amazon Mechanical Turk©, was conducted. Surveys were administered
to collect patient-reported opinions regarding adverse outcomes of both surgical and
nonsurgical treatment options for migraine headaches. Results The prevalence of migraine headache across all study participants was 15.6% and varied
slightly across participant demographics. Individuals ages 35–44 (2.73 migraines per
month) experienced the fewest migraine and with the lowest severity. Those individuals
ages 45+ experienced the most severe headaches (Visual Analog Scale = 44.23 mm).
Additionally, the greatest migraine frequency and severity existed among those
households with yearly income of $75,000–$100,000. The lowest injection therapy utility
scores were obtained for adverse outcomes of hematoma (47.60 mm) and vertigo (54.40
mm). Conclusions Migraine headaches remains a significant problem among the US population, with an
overall prevalence of 15.6% (approximately 50 million Americans). Additionally,
physicians interesting in offering minimally invasive or surgical treatment for migraine
headaches should focus on mitigating patient fears regarding clinical outcomes and cost
of care.
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Affiliation(s)
- Orr Shauly
- Keck Hospital of University of Southern California, Los Angeles, CA
| | - Daniel J Gould
- Keck Hospital of University of Southern California, Los Angeles, CA
| | - Ketan M Patel
- Keck Hospital of University of Southern California, Los Angeles, CA
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Williams KA, Lawson RM, Perurena OH, Coppin JD. Management of Chronic Migraine and Occipital Neuralgia in Post 9/11 Combat Veterans. Mil Med 2019; 184:e207-e211. [DOI: 10.1093/milmed/usy405] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 09/24/2018] [Accepted: 11/29/2018] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
The rate of chronic migraine (CM) has been shown to be 20% or greater in the post 9/11 combat veteran population with a history of traumatic brain injury, while the rate is much lower at 3–5% in the general population. Studies have shown that medications such as oral topiramate or intramuscular injections of onabotulinum toxin A (Botox) have been used for CM prevention, and occipital blocks have been shown to be helpful in treating occipital neuralgia and short-term relief of CM. However, there are no known studies that have specifically evaluated the use of Botox and occipital blocks for reducing headache frequency in the US veteran population. The purpose of this study was to evaluate the effectiveness of using occipital blocks and Botox as dual therapy for reducing headache frequency in post 9/11 combat veterans with CM, occipital neuralgia, and a history of TBI or neck trauma.
Materials and Methods
Following Institutional Review Board approval, a retrospective chart review was completed on post 9/11 combat veterans treated in a headache clinic located at the Central Texas Veteran Health Care System. The electronic medical record was used to retrieve the charts of post 9/11 combat veterans who (1) had a confirmed deployment-related history of TBI or neck trauma; (2) were diagnosed with CM and occipital neuralgia; and (3) were treated in the headache clinic between January 1, 2014 and December 31, 2015 with the administration of occipital blocks and Botox within the first six months. Of 282 charts that were reviewed, a total of 30 (N = 30) veterans fit the criteria. The mean number of self-reported headache days per month (28 days) for the month prior to starting treatment was compared to the number of headache days per month (28 days) 6 months after initiation of therapy.
Results
Results revealed that the mean number of headache days in the month prior to treatment was 24.1 (22.0, 25.7). The mean number of headache days in the month post-treatment (6 months after the initiation of dual therapy with occipital blocks and Botox) was 12.9 (9.7, 16.4). The mean difference in the number of headache days from pre- to post-treatment (pre-treatment minus post-treatment) was 11.2 (8.2, 14.2).
Conclusion
This study evaluated the effectiveness of using occipital blocks and Botox as dual therapy for reducing headache frequency for post 9/11 combat veterans with CM, occipital neuralgia, and a history of TBI or neck trauma. Results revealed a statistically significant reduction in the number of headache days per month after the dual therapy. There were multiple limitations to the study to include a small sample size, lack of a control group, self-reported headaches for only 1 month pre-and post-treatment, and no control for other interventions or events which may have influenced the outcome. There is a strong need for randomized, double blinded, placebo- controlled studies involving dual therapy in this population. This study, though small, may be helpful in stimulating additional studies and treatments in this veteran population.
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Affiliation(s)
- Karen A Williams
- Central Texas Veterans Health Care System, Medical Service, 1901 Veterans Memorial Drive, Temple, TX
| | - Robin M Lawson
- University of Alabama, Capstone College of Nursing, 650 University Blvd, E, Tuscaloosa, AL
| | - Osvaldo H Perurena
- Central Texas Veterans Health Care System, (Retired) 1901 Veterans Memorial Drive, Temple, TX
| | - John D Coppin
- Central Texas Veterans Health Care System, Research Service, Biostatistician,1901 Veterans Memorial Drive, Temple, TX
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Inan LE, Inan N, Unal-Artık HA, Atac C, Babaoglu G. Greater occipital nerve block in migraine prophylaxis: Narrative review. Cephalalgia 2019; 39:908-920. [DOI: 10.1177/0333102418821669] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objectives The importance and popularity of peripheral nerve block procedures have increased in the treatment of migraine. Greater occipital nerve (GON) block is a commonly used peripheral nerve block method, and there are numerous researches on its use in migraine treatment. Materials and methods A search of PubMed for English-language randomized controlled trials (RCT) and open studies on greater occipital nerve block between 1995 and 2018 was performed using greater occipital nerve, headache, and migraine as keywords. Results In total, 242 potentially relevant PubMed studies were found. A sum of 228 of them which were non-English articles and reviews, case reports, letters and meta-analyses were excluded. The remaining articles were reviewed, and 14 clinical trials, seven of which were randomized-controlled on greater occipital nerve block in migraine patients, were identified and reviewed. Conclusions Although clinicians commonly use greater occipital nerve block in migraine patients, the procedure has yet to be standardized. The present study reviewed the techniques, drugs and dosages, the frequency of administration, side effects, and efficacy of greater occipital nerve block in migraine patients.
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Affiliation(s)
- Levent Ertugrul Inan
- Ministry of Health Ankara Research and Training Hospital, Neurology Clinic, Ankara, Turkey
- Bozok University, Medical School, Neurology Department, Yozgat, Turkey
| | - Nurten Inan
- Gazi University Medical School, Anesthesiology and Algology Department, Ankara, Turkey
| | | | - Ceyla Atac
- Ministry of Health Izmir Bozkaya Research and Training Hospital, Neurology Clinic, Izmir, Turkey
| | - Gulcin Babaoglu
- Ministry of Health Ankara Research and Training Hospital, Algology Clinic, Ankara, Turkey
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García-Magro N, Martin YB, Negredo P, Avendaño C. The greater occipital nerve and its spinal and brainstem afferent projections: A stereological and tract-tracing study in the rat. J Comp Neurol 2018; 526:3000-3019. [PMID: 30080243 DOI: 10.1002/cne.24511] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 07/27/2018] [Accepted: 08/02/2018] [Indexed: 12/27/2022]
Abstract
The neuromodulation of the greater occipital nerve (GON) has proved effective to treat chronic refractory neurovascular headaches, in particular migraine and cluster headache. Moreover, animal studies have shown convergence of cervical and trigeminal afferents on the same territories of the upper cervical and lower medullary dorsal horn (DH), the so-called trigeminocervical complex (TCC), and recent studies in rat models of migraine and craniofacial neuropathy have shown that GON block or stimulation alter nociceptive processing in TCC. The present study examines in detail the anatomy of GON and its central projections in the rat applying different tracers to the nerve and quantifying its ultrastructure, the ganglion neurons subserving GON, and their innervation territories in the spinal cord and brainstem. With considerable intersubject variability in size, GON contains on average 900 myelinated and 3,300 unmyelinated axons, more than 90% of which emerge from C2 ganglion neurons. Unmyelinated afferents from GON innervates exclusively laminae I-II of the lateral DH, mostly extending along segments C2-3 . Myelinated fibers distribute mainly in laminae I and III-V of the lateral DH between C1 and C6 and, with different terminal patterns, in medial parts of the DH at upper cervical segments, and ventrolateral rostral cuneate, paratrigeminal, and marginal part of the spinal caudal and interpolar nuclei. Sparse projections also appear in other locations nearby. These findings will help to better understand the bases of sensory convergence on spinomedullary systems, a critical pathophysiological factor for pain referral and spread in severe painful craniofacial disorders.
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Affiliation(s)
- Nuria García-Magro
- Autonoma University of Madrid, Medical School, Department of Anatomy, Histology & Neuroscience, Madrid, Spain
| | - Yasmina B Martin
- Francisco de Vitoria University (UFV), Department of Anatomy, Faculty of Health Sciences, Madrid, Spain
| | - Pilar Negredo
- Autonoma University of Madrid, Medical School, Department of Anatomy, Histology & Neuroscience, Madrid, Spain
| | - Carlos Avendaño
- Autonoma University of Madrid, Medical School, Department of Anatomy, Histology & Neuroscience, Madrid, Spain
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