Balance and Pain Scores Improve After Occipital Nerve Blocks from Initial Cranio-cervical Trauma

Abstract

Patients with occipital neuritis/neuralgia secondary to craniocervical trauma obtain improvement in pain and balance scores with occipital nerve blocks. Concussions result from craniocervical trauma, frequently leading to post-traumatic occipital neuritis. Studies have shown that occipital neuritis triggers headaches, neck pain, insomnia, cognitive changes, and imbalance; symptoms similar to concussions. This is a retrospective cohort study of patients who have sustained craniocervical trauma. Documented was mechanism of injury, diagnosis of concussion, occipital neuritis on exam, and imbalance. Balance was quantified by using number of errors in tandem stance and modified BESS scoring from SCAT-5. Also included, number of steps in tandem gait with eyes open and closed. Pain was measured using 100 mm visual analog scale (mean VAS). Objective findings were measured before and after occipital nerve blocks. Occipital nerve blocks were a combination of lidocaine, bupivacaine, and either triamcinolone or methylprednisolone. Symptomatic sides had blocks placed over greater occipital, lesser occipital, and third occipital nerves. Data results were collected from 205 patients, ages 4-85 years old, and 127 females. Occipital nerve blocks with steroids showed significant reduction in mean VAS pain scores from 39.6 mm to 24.9 mm (p < 0.001). Tandem stance assessment of balance showed reduction of errors from 3.9 to 1.2 (p < 0.001). Steps taken during tandem gait increased from 8 to 9 steps (p < 0.001) and 4.3 to 6.2 (p < 0.001) for eyes opened and eyes closed, respectively. There was a statistically significant improvement in pain and balance scores after occipital nerve blocks. Then what is the prevalence of occipital neuritis in concussions? How do we differentiate concussion symptoms from occipital neuritis/neuralgia symptoms? Pain and balance disruption are found in each disorder, but with occipital nerve blocks, we're able to alleviate both symptoms. Therefore, it is important to evaluate for both concussion and occipital neuritis when assessing cranio-cervical trauma.