Greater Occipital Nerve Block as an Effective Intervention for Medically Refractory Pediatric Migraine: A Retrospective Study.

Abstract

Background Migraine is a common complaint worldwide, spanning all ages, but is not so well investigated in children and adolescents. Pediatric migraines incur significant health and social consequences with the most incisive effects seen in school performance, physical health, and mental well-being, making early effective management of pediatric migraine desirable. However, unlike adult migraine, the treatment for pediatric migraine has not been well established, which is especially true for the treatment of medically refractory migraine in children. Methodology We conducted a retrospective study to assess the feasibility of greater occipital nerve (GON) blocks as a therapeutic option for medically refractory migraine in children. We recruited subjects under 18 years old with a severe medically refractory headache that was affecting day-to-day life and who consented to receive a GON block. GON block effectivity was assessed through follow-up consultations and a post-procedural questionnaire. Results Six subjects received a first-time GON block for medically refractory migraine (mean age = 12 years and three months old, age range = 10 to 15 years old, three out of six subjects were female). We found that GON block was effective in all six patients for treatment of medically refractory migraine as assessed through follow-up consultations and a questionnaire sent out six weeks post-intervention. GON block was generally tolerable with only one patient reporting side effects (migraine flare-up for three days) post-intervention. Repeat injection was performed in four out of six patients, all of whom reported a repeat benefit. Conclusions We conclude that GON block is a feasible therapeutic option for the management of medically refractory migraine in children.