The efficacy of ultrasound-guided multifidus cervicis plane block versus greater occipital nerve block for cervicogenic headache

Zenat Eldadamony Mohamed,Ali A Abou Elmaaty,Mohamed E Flifel,Carmen Ali Zarad

doi:10.1186/s41983-020-00262-4

Abstract

IntroductionTraditionally, non-invasive and invasive techniques were used for the treatment of cervicogenic headache (CH). Greater occipital nerve block is the most frequent peripheral nerve block invasive technique used for the management of cervicogenic headache. The purpose of this prospective, double-blinded study was to compare the efficacy of two different techniques: multifidus cervicis plane block and greater occipital nerve block in the treatment of refractory cervicogenic headache by using ultrasound.MethodsSixty patients with cervicogenic headache were recruited and diagnosed according to the ICHD-III beta version. The patients were divided into two groups, one group was for greater occipital nerve block and the other group was for multifidus cervicis plane block with ultrasound-guided.ResultsVisual analog scale (VAS) was 2.09% in the multifidus cervicis plane block (MCPB) group and was 2.22% in the greater occipital nerve block (GONB) group with a median reduction of − 4.33 and − 3.048, respectively, at 2-week visits with a statistically significant difference better in the MCPB group (P < 0.001). At 4 weeks visits, VAS scale was better in the MCPB group than in the GONB group (3.79 and 4.44, respectively) with a median reduction in VAS scale (− 3.27 and − 3.095, respectively) and statistically significant differences between both groups (P = 0.020).ConclusionBoth the ultrasound-guided multifidus cervicis plane block and greater occipital nerve block are effective as intervention techniques in the treatment of refractory cervicogenic headache. These techniques are simple, safe, more reliable with less side effects, and often reduce the requirements of analgesic drugs.

Highlights

Non-invasive and invasive techniques were used for the treatment of cervicogenic headache (CH)
Cervicogenic headache (CH) is described as a chronic hemi-cranial pain resulted from a disorder of the cervical spine and its anatomic structures innervated by the C1, C2, and C3 cervical spinal nerves [4]
Patients not fulfilling the criteria of cervicogenic headache International Classification of Headache Disorder (ICHD)-III beta version, patients with a history of occipital nerve stimulation, patients with a history of occipital nerve injection, patients with a history of any occipital region surgical intervention, patients with a history of allergic reaction to any of materials used in the procedures, pregnant or lactating patients, patients with uncontrolled hypertension, patients with uncompensated congestive heart failure, patients with uncontrolled diabetes mellitus, patients with chronic liver disease, patients with chronic renal failure, patients with infectious and/or inflammatory diseases, patients with neoplasm and/or vascular disease, and patients with antiplatelet or anticoagulant therapy that may interfere with the procedure were excluded from this study

Summary

Introduction

Non-invasive and invasive techniques were used for the treatment of cervicogenic headache (CH). Greater occipital nerve block is the most frequent peripheral nerve block invasive technique used for the management of cervicogenic headache. Headache is one of the most prevalent causes of chronic pain with its incidence of about 30% in adults [1]. In 2004, the International Headache Society classified headache into primary and secondary types in which cervicogenic headache (CH) was considered a secondary type [2], while the International Classification of Headache Disorders, 3rd edition (beta version), reported the Cervicogenic headache (CH) is described as a chronic hemi-cranial pain resulted from a disorder of the cervical spine and its anatomic structures innervated by the C1, C2, and C3 cervical spinal nerves [4]. Regional anesthetic techniques, pulsed radiofrequency, or subcutaneous occipital nerve stimulation are considered minimally invasive procedures used for the treatment of refractory cervicogenic headache [13]

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