Greater Occipital Nerve Blockade Research Articles

Greater Occipital Nerve Blockade in the Treatment of Tension-type Headaches in the Emergency Department

Greater Occipital Nerve Blockade in the Treatment of Tension-type Headaches in the Emergency Department

The effect of anesthetic blockade of greater occipital nerve during the withdrawal period of the medication overuse headache treatment.

<p>Discontinua&shy;tion of medication still remains a key element in the treatment of medication overuse headache (MOH), but there is no consensus on the withdrawal procedure. We aimed to share the promising results of anesthetic blockade of greater occipital nerve (GON), which can be an alternative to existing treatments during the early withdrawal period of MOH treatment.</p>. <p>This study was conducted using regular electronic medical records and headache diaries of patients diagnosed with MOH and treated with anesthetic GON blockade with 0.5% bupivacaine solution in a specia&shy;lized headache outpatient clinic. A total of 86 patients who developed MOH while being followed up for chronic migraine were included in the study.</p>. <p>The treatment schemes for MOH are based on expert consensus and withdrawal strategies are the most challenging part of treatment. In our study, numerical rating scale for headache intensity, overused medication consumption per month, headache frequency (day/month) and the duration of each attack (hour/day) decreased significantly in the first month compared to pre-treatment (p &lt; 0.01).&nbsp;</p>. <p>Conclusion &ndash; Our study suggests that GON blockade can be used as a good alternative therapy in the treatment of MOH.</p>.

Comparison of the clinical efficacy of ultrasound-guided GON blockade using low and high concentrations of bupivacaine in chronic migraine.

In this study, it was aimed to retrospectively compare the effect of greater occipital nerve (GON) block performed with ultrasonography using low (0.3%) and high (0.5%) concentrations of bupivacaine on pain scores and patient satisfaction in chronic migraine (CM). The mean number of days with pain, the mean duration of pain in the attacks, and the highest numerical rating scale (NRS) scores recorded in the 1 month preblock and 1 and 3 months postblock of 80 patients (40 for Group 1, 0.3% bupivacaine; 40 for Group 2, 0.5% bupivacaine) who underwent ultrasonography-guided GON block were recorded from the patient file data. According to the protocol applied by our clinic, GON block was applied to each patient 6 times with the same procedures, in total. While there was a statistically significant difference between the groups in terms of the number of days with pain and the maximum NRS score in the 1-month preblock evaluation (p = 0.01, p < 0.001), at 3 months postblock, no statistical difference was observed in terms of the number of days with pain, duration of pain, or NRS score (p = 0.961, p = 0.108, and p = 0.567). In the intragroup evaluations, at 3 months postblock, the number of days with pain decreased from 17.5 days to 7 days in Group 1 and from 24.0 days to 8.0 days in Group 2. The duration of pain and maximum NRS values were statistically significantly decreased in the intragroup evaluation in both groups pre and postblock. Complications arising from the procedure and the local anesthetic used are essential points to consider in applying GON block. In CM treatment using GON block application, a similar effect to the standard local anesthetic application (0.5%) can be achieved by administering local anesthetic at a lower dose (0.3%).

Comparison of outcomes of transnasal sphenopalatine ganglion and ultrasound-guided proximal greater occipital nerve blockades in chronic migraine

Background &amp; Objective: A need exists for prophylactic treatment options for chronic migraine. Our aim was to evaluate and compare the effect of greater occipital nerve (GON) and transnasal sphenopalatine ganglion (SPG) blockade on headache days, responder rate, attack severity, attack frequency, and medication overuse in patients with chronic migraine. Methods: This was a retrospective study. The GON blockade was performed at the proximal level under ultrasound guidance with 1.5 cc 0.5% bupivacaine, and the SPG blockade was performed transnasally with 0.5 cc 0.5% bupivacaine applied for 30 minutes with swab sticks. Patients who completed bilateral blocks applied in four weekly sessions were included in the analysis. Results: Seventy patients (GON=37, SPG=33) were included in the study. Both groups showed a significant improvement in the number of days with headache, severity of attacks, and frequency of attacks at the first- and third-month follow-up visits compared to the baseline (p&lt;0.001). Responder rates were similar at the first- and third-month follow-up visits (r= 3.707, p=0.054; r=0.071, p=0.790, respectively). At the third-month follow-up, the prevalence of medication overuse decreased from 78% to 13% in the GON group and from 57% to 9% in the SPG group, and these differences were statistically significant (p&lt;0.001 for both groups). No significant difference was noted in efficacy between the treatment groups (p=0.714). No significant adverse effects occurred in either group. Conclusion: Both proximal GON blockade and minimally invasive SPG blockade are effective and safe options for prophylaxis in patients with chronic migraine.

Morphometric Evaluation of Occipital Artery

Objective: Occipital artery anatomy should be well known in order to minimize complications that may occur in the occipital artery, which is closely adjacent to this nerve, during greater occipital nerve blockade. In this study, it is aimed to evaluate the morphometric relationship of the occipital artery with neighboring anatomical structures in order to prevent damage during clinical applications. Materials and Methods: This study was carried out using CTA images of the head and neck region of patients who applied to Balikesir University Medical Faculty Training and Research Hospital for various reasons between 2015 and 2021. In the study, CTA images of 85 individuals aged 35-63 years were evaluated morphometrically using Radiant DICOM viewer 64-bit computer software. The obtained data were transferred to SPSS Version 25 software and analyzed quantitatively. Results: According to the results obtained from the study, no significant difference was found between the variables and genders. As the age of the individual increased, it was observed that the left occipital artery was located more inferolateral to the external occipital protuberance. As a result of the data obtained, a negative correlation was observed between the closest distance between the right OA-ML and the right EOP-ML and the spinous process of the seventh cervical vertebra. Conclusion: In line with the average values obtained as a result, it is thought that an injection to the central point of the triangular area, which is formed as a result of combining the reference points in the posterior occiput, may be safer in order to protect the occipital artery.

Primer baş ağrılı hastalarda büyük oksipital sinir blokajı ve erken dönem sonuçları

Purpose: Peripheral nerve blocks have long been used in headache treatment and greater occipital nerve (GON) blocks are the most frequently preferred peripheral nerve blocks in patients with headaches in the past years. In this study, the efficacy of GON blocks in patients with primary headache disorders was evaluated.&#x0D; Materials and Methods: This retrospective cohort study was undertaken in April 2021 and April 2022. One hundred twenty-one patients with primary headache disorders were included. Changes in the duration and frequency of headache attacks, pain severity, and type of oral medication before and after the injection treatment during the first and third months of follow-up were evaluated.&#x0D; Results: The number of headache attacks decreased from 13 to 5 and the visual analogue scale(VAS) score decreased from 9 to 5 at the end of the third month in the migraine group. Similarly, the number of headache attacks decreased from 17 to 7 and the VAS score decreased from 8 to 4 in tension-type headache (TTH) group. Improvements in all parameters were found to be statistically significant in both groups.&#x0D; Conclusion: GON block is a low-cost, rapid and minimally invasive treatment, and our data support that this method can be an effective treatment option in patients with migraine and TTH who are resistant to oral medication by reducing the number, frequency and severity of headache attacks. In conclusion, GON blockade should be considered by clinicians as a primary treatment option in patients with migraine and TTH resistant to oral medication.

Using GON block as a diagnostic block: Investigation of clinical efficacy of GON radiofrequency treatment for migraine patients

Objective: This retrospective study aimed to investigate the clinical efficacy of GON pulsed radiofrequency (PRF) treatment in migraine patients who did not respond adequately to treatment with greater occipital nerve (GON) blockade. Method: Twenty-seven patients with recurrent episodic migraines or chronic migraines were included in the study. GON blockade was performed bilaterally once a week – four times over a one-month duration. PRF treatment was performed once for those patients who did not show an adequate response to GON blockade, and the treatment was directed at the same sites as the GON blockade. The number of migraine attacks in the preceding 30 days, the total number of triptan tablets taken, the average duration of headache and the highest VAS scores at the first, third and sixth-month visits were recorded. Results: The number of severe migraine attacks, total analgesic use and the maximum duration of migraine episodes were recorded in this study. All these parameters showed a significant decrease from the first month after GON PRF treatment as compared to both the baseline as well as to treatment one month after GON block. In addition, this clinical improvement was sustained up to six months after PRF treatment. Conclusion: Our results suggest that GON PRF treatment is a viable treatment approach in the case of migraine patients who do not respond adequately to treatment with GON blockade.

Interest in and exposure to headache disorders among neurology residents in Denmark: A nationwide cross-sectional survey.

Headache disorders constitute a leading cause of disability worldwide, but there is a consistent absence of awareness and educational activities for healthcare providers across regions. Thus, we found it timely to identify potential structural challenges and factors that may affect acquisition of knowledge of headache disorders and their management during their 4-year residency. We conducted a nationwide cross-sectional survey of residents in neurology in Denmark including, but not limited to, questions on interest in neurological subspecialties and disorders, adequacy of training in headache disorders, exposure to headache disorders during training including time spent on headache disorders, exposure to specialist outpatient clinics, whether their hospital have a tertiary headache clinic, training in specific procedures (anesthetic blockade, e.g., greater occipital nerve blockade, and onabotulinumtoxinA for headache), and an estimate of proportion of cases with headache among patients managed in the last week. The survey was distributed to 127 residents in Denmark between March 2022 and April 2022. Of these, 59 (47%) completed all questions of the survey. Headache disorders were the fourth most popular subspecialties among respondents (n=15 [25%]) following movement disorders (n=27 [46%]), vascular neurology (n=26 [44%]), and neuromuscular disorders (n=25 [42%]). The mean number of hours spent in a course or a structured educational activity in headache disorders during residency was 12.1 h. Half of respondents (n=27 [46%]) reported that they perceived their training in headache disorders to be inadequate. Even in Denmark, a country with excellent headache services, half of residents in neurology report an inadequate training despite a higher-than-average number of hours of structured educational activities. These findings should incentivize stakeholders to make structural changes to improve education in headache disorders during the most fundamental years of training.

Greater occipital nerve blockade in cluster headache: effectiveness and safety of a combined injection protocol.

Greater occipital nerve blockade in cluster headache: effectiveness and safety of a combined injection protocol.

Are more nerve injections in the same session more effective in migraine treatment? 3-month follow-up results.

Peripheral nerve blockade techniques have been developed for both acute and prophylactic treatment of migraine. Our aim was to compare pain parameters between the groups of patients who only had greater occipital nerve blockade (GON), and those who also had blockade to the supraorbital nerve (SON) and infraorbital nerve (ION) together with greater occipital nerve blockade, in order to reduce pain more effectively in migraine patients. 50 patients diagnosed with migraine were included in our study. 22 patients underwent only bilateral GON blockade (GONB), and 28 patients underwent bila-teral GON blockade and bilateral SON and ION blocka-des (MCNB). In both groups, the number of headache days and visual analog scale scores of the patients were noted in the first month before the injection, in the first, second and third months after the injections (injections were applied to patients 3 times with one-month intervals). While the number of headache days before injection was 9.6 days/month in the GONB group and 9.3 days/month in the MCNB group, it was 6.2 days/month and 5.2 days/month after the first injection, 5.3 days/month and 3.8 days/month after the second injection, and 3.9 days/month and 2.8 days/month after the third injection, respectively (p < 0.01). While the visual analog scale scores of both groups were 8.1 before injection, it decreased to 5.9 and 6.0, respectively, after the third injection. There was no significant difference in the reduction of pain parameters between only GON blockade and SON and ION blockades in addition to GON blockade.

Editorial: Neuroimaging: How Can Clues from the Brain Help Pain Management?

Editorial: Neuroimaging: How Can Clues from the Brain Help Pain Management?

Efficacy of Greater Occipital Nerve and Supraorbital Nerve Blockade in The Treatment of Acute Migraine Attack

Objective: Migraine is the most common neurological disorder among primary headaches that can cause loss of quality of life. Medical agents are generally used for the treatment and prophylaxis of acute migraine attack. However, the effectiveness of pericranial nerve blocks in the treatment and prophylaxis of acute attacks has been experienced for many years. In this study, we investigated the effectiveness of bilateral greater occipital nerve (GON) and supraorbital nerve (SON) blockade in terminating acute migraine attacks that did not improve with medical treatment.&#x0D; Material and Method: In this retrospective study, 191 patients with acute migraine attacks resistant to medical treatment were evaluated. First GON block was applied to all patients, SON block was applied to patients whose visual analog scale (VAS) did not fall below ‘5’ at the fifth minute after GON block. The zero, fifth and 30th mi-nute VAS results were evaluated.&#x0D; Results: 76.96 % of the patients were women. Subraorbital nerve blockade (22.51%) was applied in addition to those with a VAS value above 5 at the 5th minute after bilateral greater occipital nerve blockade. Pericranial nerve blockade including bilateral GON and SON blockade improved the VAS level in 97.4% of our cases (mean VAS; fifth min: 1.3769±1.9746, 30th min: 0.3979±1.3013).&#x0D; Conclusion: The results of our study show that pericranial nerve blockages are beneficial in the treatment of acute migraine attacks

Greater occipital nerve block efficacy in COVID‑19 associated headache: a preliminary study

COVID‑19 is an infection caused by the new coronavirus SARS‑CoV‑2. Headache is one of the most common neurological findings. In the treatment of various chronic headaches, the greater occipital nerve (GON) block is often used as a safe and effective method. The aim of our study was to investigate the effectiveness of the GON block in the treatment of headaches observed in COVID‑19 patients. Between March and May 2020, 27 patients (with laboratory‑confirmed 2019‑nCoV infection by next‑generation sequencing confirmation of real‑time PCR) that had moderate or severe headache associated with COVID‑19 and treated with a single session of GON block were retrospectively analyzed. The visual analogue scale (VAS) values and the number of analgesic usage of patients were recorded before and after the blockade on the 1st and 10th days. Fifteen (55.6%) patients included in the study were male and twelve (44.4%) were female. In terms of VAS values, the difference between pre‑treatment and post‑treatment values on the 1st and 10th days was found statistically significant. Likewise, the difference between analgesic use before and after the procedure was statistically significant. GON block appears to be an effective pain management method in COVID‑19 related headache, and it revealed promising reductions in pain scores and analgesic usage. As well as we know, this is the first study of "COVID‑19 associated headache treated with GON blockade". More long term and well‑designed prospective studies with more participants are needed to better define this headache and develop effective treatment strategies.

Addition of lesser occipital nerve blockade to greater occipital nerve blockade in patients with chronic migraine

Objectives: The aim of this study was to compare greater occipital nerve blockade (GONB) alone and GONB combined with lesser occipital nerve blockade (LONB) in chronic migraine patients. Methods: Patients were randomly divided into two groups: Group A consisted of 22 patients who received only GONB; while Group B consisted of 20 patients who underwent GONB and LONB. The demographics and clinical characteristics of the patients were evaluated. The injections were given unilaterally and to the side where the subjects experienced greater pain. GONB with or without LONB was performed on each patient once a week for 4 weeks and then two more times a month apart; 6 times in total. The number of headache days, severity of attacks and duration of headache episodes was recorded from headache diaries before treatment and the on the first, second and third month following the start of treatment. Treatment efficiencies were evaluated within and between the groups. Results: The duration of pretreatment headaches was significantly longer in Group B (p=0.032). There were no differences between the groups in terms of other demographic and clinical characteristics. When the treatments applied in group A and group B were evaluated separately compared to the control group, there was a statistically significant decrease in the number of headache days, VAS scores and headache duration (p &lt;0.05). When the results of treatment between groups were compared, there was no difference in terms of the number of headache days and VAS scores. Although the duration of headache was longer in the pretreatment period in group B, this difference disappeared on posttreatment follow-up (p&gt;0.05). Conclusions: This study suggests that there is no difference in the number of headache days or headache intensity between GONB alone or in combination with LONB in chronic migraine patients. GONB combined with LONB in patients may be more effective than GONB alone when headaches of longer duration are present.

Comparison of greater occipital nerve and supra orbital nerve blocks methods in the treatment of acute migraine attack: A randomized double-blind controlled trial

ObjectiveThe main goal of this investigation is to compare the Greater Occipital Nerve (GON) and Supra Orbital Nerve (SON) block methods used in the treatment of migraine attacks in the ED with each other, in combination, and with a placebo. MethodsThis study was planned as a single center, prospective, double-blind, randomized control study. The patients were divided into 4 groups: GON, SON, Combined, and Placebo. Groups were named according to the nerve areas that were blocked. Therefore1% lidocaine for nerve blockade and 0.9% NaCl for placebo effect was used. Along with the time of admission, baseline pain scale values, as well as recordings at 30 and 60 min in addition to the Visual Analog Scale (VAS) at the 120th min. and Likert-Type (LT) Verbal scale at the 120th min. were measured. The primary outcome of this study was a change in the VAS and LT values at the 0–120th minute after treatment ResultsIn this study, 128 patients in 4 groups were included in the analysis. In the GON group, SON group, and Combined group, the change observed at the 120th minute scores compared to baseline VAS scores was higher than Placebo group [OR (95% CI) = −17.4 (−24.8, −9.9), 32.1 (23.8, 40.3), 49.5 (41.9, 57), respectively]. In inter-group comparison, it was found that the VAS and LT scores of the Combined group and the GON group improved at a higher rate than the SON group ConclusionsSON blockade, GON blockade, and a combination of these two blockades are effective treatment methods in acute migraine attack. Performing a GON or Combined blockade for migraine attack causes greater pain reduction than SON blockade.

Suboccipital steroid injection alone as a preventive treatment for cluster headache

BackgroundSuboccipital steroid injection can be used as a preventive treatment for episodic and chronic cluster headache (CH). In recent studies, prophylactic treatment has been used in addition to suboccipital steroid injection. In this study, we aimed to investigate the effectivity of the sole use of rapid- and long-acting steroid injections without prophylactic treatment in patients with episodic and chronic CH. MethodsThe retrospective study included 51 patients with episodic and chronic CH that underwent greater occipital nerve (GON) blockade with a single dose of rapid- and long-acting steroid injection without additional prophylactic treatment. The frequency, severity, and duration of attacks after GON blockade as well as the side effects and long-term outcomes were reviewed. ResultsIn 28 (54.9%) patients, no attack occurred after GON blockade and cluster bouts were aborted. Mean duration of attacks was 86.67 ± 37.45 min before the treatment. However, in the 23 patients that had at least one attack after GON blockade, the mean duration of attacks was 31.73 ± 36.10 min between post-treatment days 0–3, 29.35 ± 40.49 min between post-treatment days 4–10, 28.48 ± 42.17 min between post-treatment days 11–28, and 35.65 ± 46.55 min after the post-treatment day 28 (p < 0.001). Moreover, 10 (37.04%) out of 27 patients with episodic CH who periodically had one or two cluster bouts in a year had no CH attack at the time of the expected subsequent cluster bout. ConclusionGON blockade is a practical, reliable, and cost-effective treatment option for patients with episodic and chronic CH. Moreover, GON blockade is highly effective in reducing headache attacks and even aborting cluster bouts in CH patients without requiring additional prophylactic treatment.

Greater occipital and supraorbital nerve blockade for the preventive treatment of migraine: a single-blind, randomized, placebo-controlled study

Objective: Nerve injections have been used for the acute and preventive treatment of migraine in recent decades. Most of these injections focused on greater occipital nerve (GON) blockade. However, few studies were placebo controlled, and only a few of them investigated GON and supraorbital nerve (SON) blockade together. This study aimed to evaluate the efficacy of GON and SON blockade with local anesthetics for the preventive treatment of migraine without aura.Methods: Eighty-seven patients diagnosed with migraine without aura were included in the study. Patients were divided randomly. One group was injected with 1% lidocaine, the other group was injected with 0.9% saline. GON and SON injections were done bilaterally. The injections were repeated weekly for 3 weeks. Patients were followed up for 2 months to assess clinical response.Results: Seventy-one patients completed the study. After 2 months, the number of headache days decreased significantly from 12.8 ± 10.9 to 5.3 ± 7.4, and VAS decreased from 8.3 ± 1.0 to 5.5 ± 1.9 in the blockade group. The number of headache days decreased from 12.4 ± 10.3 to 7.5 ± 7.2 and VAS decreased from 8.2 ± 1.1 to 7.4 ± 1.3 in the placebo group. Response was seen in 65.1% of the patients in the blockade group (65.4% for episodic migraine, 64.7% for chronic migraine) and 28.6% of the patients in the placebo group. The difference was significant.Conclusions: The results suggest that GON and SON blockade with lidocaine was more effective than the placebo in the prophylactic treatment of both episodic and chronic migraine.Trial registration: ClinicalTrials.gov identifier: NCT03435185.

Comparing the injectate spread and nerve involvement between different injectate volumes for ultrasound-guided greater occipital nerve block at the C2 level: a cadaveric evaluation

PurposeThe spread patterns between different injectate volumes have not yet been investigated in ultrasound-guided greater occipital nerve (GON) block at the C2 level. This cadaveric study was undertaken to compare the spread pattern and nerve involvements of different volumes of dye using this technique.Materials and methodsAfter randomization, ultrasound-guided GON blocks with 1 or 5 mL dye solution were performed at the C2 level on the right or left side of five fresh cadavers. The suboccipital regions were dissected, and nerve involvement was investigated.ResultsTen injections were successfully completed. In all cases of 5 mL dye, we observed the deeply stained posterior neck muscles, including the suboccipital triangle space. The suboccipital and third occipital nerves, in addition to GONs, were consistently stained when 5-mL dye was used in all injections (100%). Although all GONs were successfully stained in the 1-mL dye cases, three of five injections (60%) concomitantly stained the third occipital nerves.ConclusionThe clinical efficacy of this technique using the 5-mL injectate seems unlikely to arise from the blockade of GON alone. Instead, its efficacy likely arises from the blockade of most nerves originating from the dorsal ramus of the upper cervical spinal nerve at the suboccipital area. Even using 1 mL of injectate may not guarantee blockade of the GON alone.

Comparing the injectate spread and nerve involvement between different injectate volumes for ultrasound-guided greater occipital nerve block at the C2 level: a cadaveric evaluation.

The spread patterns between different injectate volumes have not yet been investigated in ultrasound-guided greater occipital nerve (GON) block at the C2 level. This cadaveric study was undertaken to compare the spread pattern and nerve involvements of different volumes of dye using this technique. After randomization, ultrasound-guided GON blocks with 1 or 5 mL dye solution were performed at the C2 level on the right or left side of five fresh cadavers. The suboccipital regions were dissected, and nerve involvement was investigated. Ten injections were successfully completed. In all cases of 5 mL dye, we observed the deeply stained posterior neck muscles, including the suboccipital triangle space. The suboccipital and third occipital nerves, in addition to GONs, were consistently stained when 5-mL dye was used in all injections (100%). Although all GONs were successfully stained in the 1-mL dye cases, three of five injections (60%) concomitantly stained the third occipital nerves. The clinical efficacy of this technique using the 5-mL injectate seems unlikely to arise from the blockade of GON alone. Instead, its efficacy likely arises from the blockade of most nerves originating from the dorsal ramus of the upper cervical spinal nerve at the suboccipital area. Even using 1 mL of injectate may not guarantee blockade of the GON alone.

The effectiveness of greater occipital nerve blockade in treating acute migraine-related headaches in emergency departments.

This study aimed to evaluate the effectiveness of a greater occipital nerve (GON) blockade against a placebo and classical treatments (non-steroidal anti-inflammatory drugs+metoclopramide) among patients who were admitted to the emergency department (ED) with acute migraine headaches. This prospective-randomized controlled study was conducted on patients with acute migraine headaches. The patients were randomly assigned to 3 treatment groups: the GON blockade group (nerve blockade with bupivacaine), the placebo group (injection of normal saline into the GON area), and the intravenous (IV) treatment group (IV dexketoprofen and metoclopramide). Sixty acute migraine attack patients were assigned to 3 groups of 20 patients each. The pain severity was assessed at 5, 15, 30, and 45minutes with a 10-point pain scale score (PSS). The mean decreases in the 5-, 15-, 30-, and 45-minutes PSS scores were greater in the GON blockade group than in the dexketoprofen and placebo groups. When comparing the 30- and 45-minutes PSS changes, a statistically significant difference was found among the 3 groups (P=.03 and P=.03, respectively). A GON blockade was as effective as an IV dexketoprofen + metoclopramide treatment and superior to a placebo in patients with acute migraine headaches. Despite being an invasive procedure, a GON blockade might be an effective option for acute migraine treatment in the ED due to its rapid, easy, and safe application.