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Gaelen JI, King MR, Hajduk J, Vargas A, Krodel DJ, Shah RD, Benzon HA. Ultrasound-Guided Occipital Nerve Blocks as Part of Multi-Modal Perioperative Analgesia in Pediatric Posterior Craniotomies: A Case Series. Children (Basel) 2023; 10:1374. [PMID: 37628373 PMCID: PMC10453530 DOI: 10.3390/children10081374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/17/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023]
Abstract
Various regional anesthetics have been used for postoperative analgesia for pediatric craniotomy. In this case series, we report retrospectively collected data on postoperative pain and analgesic use in 44 patients who received ultrasound-guided occipital nerve blocks in addition to intravenous analgesic agents for posterior craniotomy procedures. In the immediate post-anesthesia care unit, pain was rated as zero or well controlled in 77% of patients, with only 43% requiring intravenous or demand patient-controlled analgesia opioids. There were no block-related complications. Occipital nerve blocks may constitute a safe and effective component of multimodal analgesia in this population.
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Affiliation(s)
- Jordan I. Gaelen
- Department of Pediatric Anesthesiology, Ann and Robert H. Lurie Children’s Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
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Lee MJ, Park JW, Chu MK, Moon HS, Chung PW, Chung JM, Sohn JH, Kim BK, Kim BS, Kim SK, Song TJ, Choi YJ, Park KY, Oh K, Ahn JY, Lee KS, Bae DW, Cho SJ. Treatment pattern and response for cluster headache in Korea: A prospective multicenter observation study. Cephalalgia 2023; 43:3331024231159627. [PMID: 36855967 DOI: 10.1177/03331024231159627] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
BACKGROUND Only limited data are available regarding the treatment status and response to cluster headache in an Asian population. Therefore, this study aimed to provide a real-world treatment pattern of cluster headache and the response rate of each treatment in an Asian population. METHODS Patients with cluster headache were recruited between September 2016 and January 2019 from 16 hospitals in Korea. At the baseline visit, we surveyed the patients about their previous experience of cluster headache treatment, and acute and/or preventive treatments were prescribed at the physician's discretion. Treatment response was prospectively evaluated using a structured case-report form at 2 ± 2 weeks after baseline visit and reassessed after three months. RESULTS Among 295 recruited patients, 262 experiencing active bouts were included. Only one-third of patients reported a previous experience of evidence-based treatment. At the baseline visit, oral triptans (73.4%), verapamil (68.3%), and systemic steroids (55.6%) were the three most common treatments prescribed by the investigators. Most treatments were given as combination. For acute treatment, oral triptans and oxygen were effective in 90.1% and 86.8% of the patients, respectively; for preventive treatment, evidence-based treatments, i.e. monotherapy or different combinations of verapamil, lithium, systemic steroids, and suboccipital steroid injection, helped 75.0% to 91.8% of patients. CONCLUSION Our data provide the first prospective analysis of treatment responses in an Asian population with cluster headache. The patients responded well to treatment despite the limited availability of treatment options, and this might be attributed at least in part by combination of medications. Most patients were previously undertreated, suggesting a need to raise awareness of cluster headache among primary physicians.
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Affiliation(s)
- Mi Ji Lee
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Wook Park
- Department of Neurology, Uijeongbu St. Mary's Hospital, Catholic University of Korea College of Medicine, Uijeongbu, Korea
| | - Min Kyung Chu
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Heui-Soo Moon
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Pil-Wook Chung
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Myun Chung
- Department of Neurology, Inje University College of Medicine, Seoul, Korea
| | - Jong-Hee Sohn
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Byung-Kun Kim
- Department of Neurology, Eulji University School of Medicine, Seoul, Korea
| | - Byung-Su Kim
- Department of Neurology, Bundang Jesaeng General Hospital, Daejin Medical Center, Seongnam, Korea
| | - Soo-Kyoung Kim
- Department of Neurology and Institute of Health Science, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Tae-Jin Song
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | | | - Kwang-Yeol Park
- Department of Neurology, Chung-Ang University Hospital, Seoul, Korea
| | - Kyungmi Oh
- Department of Neurology, Korea University College of Medicine, Seoul, Korea
| | - Jin-Young Ahn
- Department of Neurology, Seoul Medical Center, Seoul, Korea
| | - Kwang-Soo Lee
- Department of Neurology, Seoul St. Mary's Hospital, Catholic University of Korea College of Medicine, Seoul, Korea
| | - Dae Woong Bae
- Department of Neurology, The Catholic University of Korea, St Vincent's Hospital, Suwon, Republic of Korea
| | - Soo-Jin Cho
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
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Chan TLH. New Daily Persistent Headache Responsive to Peripheral Nerve Blocks. Can J Neurol Sci 2021;:1-3. [PMID: 34526165 DOI: 10.1017/cjn.2021.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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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 Med 2021; 23:164-188. [PMID: 34382092 DOI: 10.1093/pm/pnab236] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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5
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Chan TLH. Hemicrania continua secondary to pituitary macroadenoma responsive to nerve blocks: A case report. Headache 2021; 61:798-800. [PMID: 34105160 DOI: 10.1111/head.14121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/06/2021] [Accepted: 03/17/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Tommy Lik Hang Chan
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada
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Abstract
BACKGROUND Occipital nerve blocks are commonly used in the treatment of different types of refractory headaches. The procedure is considered safe, and serious complications have rarely been described. CASE PRESENTATION We report a serious complication of occipital nerve blockade secondary to the penetration of local anesthetic and non-steroidal anti-inflammatory drugs into the posterior fossa in a patient affected by type I Arnold Chiari malformation. CONCLUSIONS This case reminds that a proper injection technique is mandatory to avoid potentially severe complications when performing occipital nerve blocks.
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Affiliation(s)
- Alessandro Pincherle
- Neurology Unit, Department of Medicine, Hopitaux Robert Schuman, Luxembourg, Luxembourg.,Department of Neurorehabilitation, IRCSS Istituto Clinico Scientifico Maugeri, Milan, Italy
| | - Serge Bolyn
- Neurology Unit, Department of Medicine, Hopitaux Robert Schuman, Luxembourg, Luxembourg
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Ebied AM, Nguyen DT, Dang T. Evaluation of Occipital Nerve Blocks for Acute Pain Relief of Migraines. J Clin Pharmacol 2019; 60:378-383. [PMID: 31595507 DOI: 10.1002/jcph.1528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 09/06/2019] [Indexed: 11/05/2022]
Abstract
Migraines are a debilitating neurological disease affecting as many as 1 of 6 adults in the United States. Occipital nerve block, consisting of a local anesthetic and/or corticosteroid, has shown to be an effective treatment for the management of migraines. Occipital nerve block has been reported to reduce migraine pain scores, frequency, and duration. We aimed to evaluate the impact of occipital nerve block for acute pain relief in patients with migraines. This was a single-center retrospective observational study conducted at a 1162-bed academic medical center in Gainesville, Florida. Included patients were ≥18 years old, diagnosed with migraine with or without aura, and received at least 1 occipital nerve block. Excluded patients received nerve blocks not specific to the occipital region. The outcomes observed were migraine pain before and after administration within the same initial encounter of receiving an occipital nerve block using a numeric pain rating scale, injection direction, medications used, duration of effect and frequency of additional injections, and adverse reactions. A total of 190 patients met the inclusion criteria, with 63% rating their pain to be 6-8 of 10 prior to an occipital nerve block. After receiving an occipital nerve block, 27% of patients reported significant or immediate relief, and 42% experienced reduced pain scores of 0-2. The majority of injections were bilateral using lidocaine with dexamethasone. Only 3% of patients reported an adverse reaction. Occipital nerve block as adjunctive therapy has shown safety and efficacy in treating patients with migraines, measured by the reduction in pain.
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Affiliation(s)
- Alex M Ebied
- University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - Duong T Nguyen
- University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - Tanaka Dang
- University of Florida College of Pharmacy, Gainesville, Florida, USA
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Christie SD, Kureshi N, Beauprie I, Holness RO. Occipital osteomylelitis and epidural abscess after occipital nerve block: A case report. Can J Pain 2018; 2:57-61. [PMID: 35005366 PMCID: PMC8730567 DOI: 10.1080/24740527.2017.1360725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Occipital neuralgia is a paroxysmal jabbing pain in the distribution of the greater or lesser occipital nerves accompanied by diminished sensation in the affected area. Occipital nerve block is a common diagnostic and therapeutic tool used in the course of occipital neuralgia and is considered a safe treatment with few localized adverse events. Occipital nerve block is also indicated for cervicogenic and cluster headache and is often used as a rescue treatment for headaches not responding to conventional therapies. We describe a case of epidural abscess formation 16 days following occipital nerve block in a patient with no underlying medical conditions. This case report emphasizes the importance of strict aseptic technique to reduce infection rates in patients undergoing this procedure, despite the overall safety of occipital nerve block. Clinicians must remain aware of acute and late complications arising postprocedure for the safe practice of this technique.
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Affiliation(s)
- Sean D Christie
- Division of Neurosurgery, Dalhousie University/QEII Health Sciences Centre, Halifax, NS, Canada
| | - Nelofar Kureshi
- Division of Neurosurgery, Dalhousie University/QEII Health Sciences Centre, Halifax, NS, Canada
| | - Ian Beauprie
- Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University/QEII Health Sciences Centre, Halifax, NS, Canada
| | - Renn O Holness
- Cornwall Regional Hospital, University of the West Indies, The University of the West Indies, Mona, Jamaica
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Juškys R, Šustickas G. Effectiveness of treatment of occipital neuralgia using the nerve block technique: a prospective analysis of 44 patients. Acta Med Litu 2018; 25:53-60. [PMID: 30210238 PMCID: PMC6130929 DOI: 10.6001/actamedica.v25i2.3757] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 05/31/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND There is a great deal of tools for treatment of occipital neuralgia but currently we are lacking a complete consensus among practitioners regarding the optimal approach to this debilitating condition. Occipital nerve block (ONB) is known as one of the management options but there is lack of scientific literature exploring its effectiveness. MATERIALS AND METHODS The prospective study was undertaken between March 2014 and February 2018 at the State Vilnius University Hospital. Forty-four patients aged from 28 to 84 years (age mean = 56.30 ± 14.71) of which 79.55% were female (n = 35) were diagnosed with occipital neuralgia (ON) and treated with a local anaesthetic and corticosteroids combination injection into the greater or greater plus lesser occipital nerve (n = 29 and n = 15, respectively) and followed up after 6 months. Analysis of the outcomes of those patients was done by comparing the Visual Analog Scale (VAS) and Barrow Neurological Institute Pain Intensity Score (BNIPIS) prior to treatment, 24 hours after the block, and at a follow-up 6 months later. Analgesic medication consumption before and after 6 months was recorded. A comparison of procedure efficacy in lidocaine and bupivacaine groups was made. Evaluation of block potency for acute and chronic pain categories was conducted as well. The success criteria were defined as patient satisfaction with own condition for at least 6 months, not requiring another block in order to stay comfortable. RESULTS Of 44 patients, 42 (95.45%) who underwent the occipital nerve block procedure showed satisfactory results for at least 6 months. Mean headache VAS scores decreased from 7.23 ± 0.93 (pre-treatment) to 1.95 ± 1.59 (24 hours after, p < 0.0001) and increased to 2.21 ± 1.73 at the follow-up after 6 months, showing no statistically significant difference between post-interventional and six-month VAS scores (p = 0.07). In all patients the necessity of medication to control pain decreased to 16.67% (n = 7) during the the check-up after 6 months. There was no statistically significant difference in the effectiveness of ONB with regard to the local anaesthetic used or the pain group targeted. Similar results were obtained comparing patients who underwent more than one ONB. CONCLUSIONS Occipital nerve block with a local anaesthetic and corticosteroids provides a safe, simple, and effective treatment method for the patient with medically-refractory occipital neuralgia.
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Affiliation(s)
| | - Gytis Šustickas
- Department of Neurosurgery, State Vilnius University Hospital, Vilnius, Lithuania
- Faculty of Medicine, Utena University of Applied Sciences, Utena, Lithuania
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Karadaş Ö, Özön AÖ, Özçelik F, Özge A. Greater occipital nerve block in the treatment of triptan-overuse headache: A randomized comparative study. Acta Neurol Scand 2017; 135:426-433. [PMID: 27666722 DOI: 10.1111/ane.12692] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2016] [Indexed: 01/03/2023]
Abstract
OBJECTIVES This study aims to investigate the efficiency of a single and repeated greater occipital nerve (GON) block using lidocaine in the treatment of triptan-overuse headache (TOH), whose importance has increased lately. MATERIALS AND METHODS In the study, 105 consecutive subjects diagnosed with TOH were evaluated. The subjects were randomized into three groups. In Group 1 (n=35), only triptan was abruptly withdrawn. In Group 2 (n=35), triptan was abruptly withdrawn and single GON block was performed. In Group 3 (n=35), triptan was abruptly withdrawn and three-stage GON block was performed. All patients were injected bilaterally with a total amount of 5 cc 1% lidocaine in each stage. During follow-up, the number of headache days per month, the severity of pain (VAS), the number of triptans used, and hsCRP and IL-6 levels were recorded three times; in the pretreatment period, in the second month post-treatment, and in the fourth month post-treatment. They were then compared. RESULTS There was a statistically significant difference in the post-treatment fourth month in comparison with the pretreatment period in Group 3 (P<.05). Compared to Group 1, the number of headache days, VAS, and decrease in triptan need in Group 3 was statistically significant compared to Group 2 (P<.05). Compared to pretreatment, in the fourth month post-treatment, both hsCRP and IL-6 levels were lower only in Group 3 (P<.05). CONCLUSIONS We are of the opinion that repeated GON block in addition to the discontinuation of medication has significant efficacy for TOH cases.
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Affiliation(s)
- Ö. Karadaş
- Department of Neurology; Ankara Mevki Military Hospital; Ankara Turkey
| | - A. Ö. Özön
- Department of Neurology; Liv Hospital; Ankara Turkey
| | - F. Özçelik
- Department of Medical Biochemistry; Gulhane Military Medical Academy, Haydarpasa Training Hospital; Istanbul Turkey
| | - A. Özge
- Department of Neurology; Mersin University School of Medicine; Mersin Turkey
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11
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Gaul C, Roguski J, Dresler T, Abbas H, Totzeck A, Görlinger K, Diener HC, Weber R. Efficacy and safety of a single occipital nerve blockade in episodic and chronic cluster headache: A prospective observational study. Cephalalgia 2016; 37:873-880. [PMID: 27313215 DOI: 10.1177/0333102416654886] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background Treatment options for cluster headache (CH) include acute, transitional and prophylactic strategies. We assessed the efficacy and safety of a single occipital nerve block (ONB) in patients with episodic (eCH) and chronic CH (cCH). Methods In this prospective, observational study 101 CH were treated with a single ONB using triamcinolone 10 mg and bupivacaine. Attack frequency, pain intensity and side effects were assessed at days 1 and 7 after ONB and thereafter weekly for 60 days until recurrence of attacks. Results Baseline mean daily attack frequency was 2.9 ± 2.5 (eCH) and 3.3 ± 2.9 (cCH), which was reduced to 0.7 ± 1.2 (eCH) and 1.1 ± 1.4 (cCH) after one day ( p = 0.08 for group difference) and to 1.1 ± 1.6 (eCH) and 1.9 ± 2.3 (cCH) after seven days ( p = 0.01 for group difference). In patients with eCH the pain-free period lasted longer compared to cCH ( p = 0.004). There was no association between the presence of local anesthesia and treatment response ( p = 0.88). No serious adverse events occurred. Conclusion ONB is an easy, safe and effective transitional treatment option in case of insufficient response of CH to treatment both in patients with eCH and cCH. Patients with eCH have a better and more sustainable treatment response.
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Affiliation(s)
- Charly Gaul
- 1 Department of Neurology, University Hospital Essen, Germany.,2 Migraine and Headache Clinic Königstein, Germany
| | - Jana Roguski
- 1 Department of Neurology, University Hospital Essen, Germany
| | - Thomas Dresler
- 3 Department of Psychiatry and Psychotherapy, University of Tübingen, Germany.,4 LEAD Graduate School & Research Network, University of Tübingen, Germany
| | - Hind Abbas
- 1 Department of Neurology, University Hospital Essen, Germany
| | - Andreas Totzeck
- 1 Department of Neurology, University Hospital Essen, Germany
| | - Klaus Görlinger
- 5 Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, Germany
| | | | - Ralph Weber
- 1 Department of Neurology, University Hospital Essen, Germany.,6 Department of Neurology, Alfried Krupp Krankenhaus Essen, Germany
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Seeger TA, Orr S, Bodell L, Lockyer L, Rajapakse T, Barlow KM. Occipital Nerve Blocks for Pediatric Posttraumatic Headache: A Case Series. J Child Neurol 2015; 30:1142-6. [PMID: 25406154 DOI: 10.1177/0883073814553973] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 09/11/2014] [Indexed: 12/26/2022]
Abstract
Posttraumatic headache is one of the most common and disabling symptoms after traumatic brain injury. However, evidence for treating posttraumatic headache is sparse, especially in the pediatric literature. This retrospective chart review evaluated the use of occipital nerve blocks in adolescents treated for posttraumatic headache following mild traumatic brain injury, presenting to the Complex Concussion and Traumatic Brain Injury clinic. Fifteen patients (mean age 15.47; range: 13-17) received occipital nerve block for posttraumatic headache. Follow-up was obtained in 14 patients at 5.57 (standard deviation = 3.52) months postinjury. The headache burden was high, with all except one having headaches 15 or more days per month (median 30, range 10-30). Sixty-four percent reported long-term response to the occipital nerve blocks, with associated improved quality of life and decreased postconcussion symptom scores (P < .05). One patient reported transient allopecia. Occipital nerve blocks are well tolerated and can be helpful in posttraumatic headache.
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Affiliation(s)
| | - Serena Orr
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada University of Ottawa, Ottawa, Ontario, Canada
| | - Lisa Bodell
- Alberta Children's Hospital, Calgary, Alberta, Canada
| | | | | | - Karen M Barlow
- University of Calgary, Calgary, Alberta, Canada Alberta Children's Hospital, Calgary, Alberta, Canada
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Kinfe TM, Schuss P, Vatter H. Occipital nerve block prior to occipital nerve stimulation for refractory chronic migraine and chronic cluster headache: myth or prediction? Cephalalgia 2014; 35:359-62. [PMID: 24989870 DOI: 10.1177/0333102414541685] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Occipital nerve stimulation (ONS) results in beneficial outcomes, with marked pain relief, in otherwise intractable chronic migraine (CM) and chronic cluster headache (CCH). Some studies have reported that a positive response to occipital nerve block (ONB) administered prior to ONS predicts a positive response to ONS. However, other studies concerned with proper patient selection claimed no predictive value for ONB. The aim of this study was to re-evaluate the usefulness and predictive value of ONB prior to ONS. METHODS Literature searches on the predictive value of ONB were performed in MEDLINE and PubMed. Patient data were extracted and a pooled analysis was performed. RESULTS The literature review revealed 133 patients with CM and seven patients with CCH who received preoperative ONB. To date, a randomized controlled study examining the relationship between ONB and ONS has not been conducted in patients with CM. CONCLUSIONS Current literature suggests that ONB does not sufficiently predict ONS responsiveness in patients with refractory CM and CCH; this important issue requires further investigation.
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Affiliation(s)
- Thomas M Kinfe
- Division of Functional Neurosurgery and Neuromodulation, Rheinische Friedrich Wilhelms University, Bonn, Germany Department of Neurosurgery, Rheinische Friedrich Wilhelms University, Bonn, Germany
| | - Patrick Schuss
- Department of Neurosurgery, Rheinische Friedrich Wilhelms University, Bonn, Germany
| | - Hartmut Vatter
- Department of Neurosurgery, Rheinische Friedrich Wilhelms University, Bonn, Germany
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14
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Sahai-Srivastava S, Subhani D. Adverse effect profile of lidocaine injections for occipital nerve block in occipital neuralgia. J Headache Pain 2010; 11:519-23. [PMID: 20665065 PMCID: PMC3476234 DOI: 10.1007/s10194-010-0244-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Accepted: 07/09/2010] [Indexed: 11/24/2022] Open
Abstract
To determine whether there are differences in the adverse effect profile between 1, 2 and 5% Lidocaine when used for occipital nerve blocks (ONB) in patients with occipital neuralgia. Occipital neuralgia is an uncommon cause of headaches. Little is known regarding the safety of Lidocaine injections for treatment in larger series of patients. Retrospective chart analysis of all ONB was performed at our headache clinic during a 6-year period on occipital neuralgia patients. 89 consecutive patients with occipital neuralgia underwent a total of 315 ONB. All the patients fulfilled the IHS criteria for Occipital Neuralgia. Demographic data were collected including age, gender, and ethnicity. The average age of this cohort was 53.25 years, and the majority of patients were females 69 (78%). Ethnicity of patients was diverse, with Caucasian 48(54%), Hispanics 31(35%), and others 10 (11%). 69 patients had 1%, 18 patients had 2% and 29 patient were given 5% Lidocaine. All Lidocaine injections were given with 20 mg Depo-medrol and the same injection technique and location were used for all the procedures. Eight patients (9%)had adverse effects to the Lidocaine and Depo-medrol injections, of which 5 received 5% and 3 received 1% Lidocaine. Majority of patients who had adverse effects were female 7(87%), and had received bilateral blocks (75%). ONB is a safe procedure with 1% Lidocaine; however, caution should be exerted with 5% in elderly patients, 70 or older, especially when administering bilateral injections.
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Affiliation(s)
- Soma Sahai-Srivastava
- Department of Neurology, Keck School of Medicine, University of Southern California, 1100 North State St, Room A4E111, Los Angeles, CA 90033, USA.
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