Occipital Nerve Block Research Articles

Greater Occipital Nerve Block with Local Anesthetics and Corticosteroids in Treatment-Resistant Chronic Migraine

Objective: We investigated the efficacy and tolerability of greater occipital nerve block with lidocaine plus betamethasone in adults with chronic migraine in whom two or more previous preventive treatments were unsuccessful.
 Methods: Ten participants were enrolled in a 24-weeks, randomized, double-blind, placebo-controlled, crossover trial conducted at a single tertiary headache center in Copenhagen (Denmark). After a 4-week run-in period, participants underwent treatment with bilateral greater occipital nerve block with lidocaine plus betamethasone (GONb) or lidocaine plus saline (placebo) with a 4-week interval wash-out phase between the 8-week crossover periods. The primary aim was to compare the number of migraine days during crossover periods after GONb or placebo. This trial is registered at ClinicalTrials.gov (NCT02686983).
 Results: This study was stopped before achieving the a priori sample size, due to a slow enrollment. Ten participants were recruited, completed the study and were included in the analyses. At the baseline, the mean number of monthly migraine days was 22.9 (range, 14-30). No difference between GONb and placebo on the reduction of monthly migraine days was observed (p = 0.147; 95% CI between 0.6 and 3.7 days). Adverse events were recorded in two patients after GONb, compared with three patients after placebo.
 Conclusions: GONb is not beneficial in patients with difficult-to-treat chronic migraine.

Second-line interventions for migraine in the emergency department: A narrative review.

Millions of patients present to US emergency departments (ED) annually for the treatment of migraine. First-line treatments, including metoclopramide, prochlorperazine, and sumatriptan, fail to provide sufficient relief in up to one-third of treated patients. In this narrative review, we discuss the evidence supporting the use of injectable (intravenous, intramuscular, or subcutaneous) medications for patients in the ED who fail to improve sufficiently after treatment with first-line medication. We used the American Headache Society's guideline, "Management of Adults with Acute Migraine in the Emergency Department: The American Headache Society Evidence Assessment of Parenteral Pharmacotherapies," published in 2016, to identify first-line medications for migraine. We then conducted a PubMed search to determine whether any evidence supported the use of these medications as second-line therapy and whether any evidence existed to support the use of injectable therapies not discussed in the guideline as second-line therapy. We identified only scant high-quality randomized data of second-line therapy. Therefore, we based our recommendations on medications that have reliably demonstrated efficacy as first-line treatment of migraine. These medications include injectable non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen. Dihydroergotamine and valproic acid have some data supporting efficacy. More recently, greater occipital nerve blocks (GONBs) have been shown to be efficacious. With the exception of meperidine, opioids have been shown to be not efficacious. Most data published to date demonstrate no role for propofol and ketamine. There are no evidence-based second-line treatments of migraine in the ED setting. For patients with migraine, who fail to improve after treatment with a first-line medication, it is reasonable to use an intravenous NSAID or intravenous acetaminophen. Alternatively, clinicians adept at performing a GONB may offer this treatment.

Could a Simple Nerve Block be Considered as a Treatment Option for Occipital Neuralgia with Both Short-Term and Long-Term Effects?

Objective: The study aims to show both the short- and long-term treatment outcome of occipital nerve block (ONB) patients with occipital neuralgia (ON).Methods: Patients who visited our hospital between 2013 and 2020 were reviewed retrospectively. Patients were excluded if the medical records were incomplete, if they had received a cervical operation, if they had a traumatic event prior to the symptom onset, or if the follow-up period was less than 3 months. ONB targeted the greater occipital nerve, the lesser occipital nerve or both. Short term follow-up period was defined as 3 months and long term was defined as 12 months. Injection consisted of a mixture of triamcinolone acetonide, lidocaine, and normal saline. Visual analogue scale (VAS) was recorded and compared before and during the follow-up to period to assess treatment outcome.Results: Clinical charts of 309 candidates were reviewed and 72 patients were excluded, making it 237 patients. VAS scores significantly decreased in both 3-month follow-up (from 7.20±0.94 to 3.48 ±1.66, p<0.05) and after 1 year follow-up (from 7.20±0.94 to 2.71±1.07, p<0.05). Only 8 patients (3.3%) were refractory to ONB and the procedure was found to be relatively safe since only 2 patients (0.8%) showed transient side effects.Conclusion: There are many treatment options for ON. However, from the results of our study, conservative treatment via ONB may have sufficient effect in controlling symptoms of ON in both short and long term.

Efficacy of interventional treatment strategies for managing patients with cervicogenic headache: a systematic review.

Cervicogenic headache (CeH) is caused by the disorder of the cervical spine and its anatomical structures. Patients who fail to respond to conservative therapies can undergo interventional treatment. The purpose of this review is to describe the various interventions and compare their relative efficacies. Although a few reviews have been published focusing on individual interventions, reviewing studies on other available treatments and establishing the most efficacious approach is still necessary. We performed a systematic review of studies available on the various interventions for CeH. The PubMed, Embase, and Cochrane databases were searched for literature published between January 2001 and March 2021. Based on the inclusion criteria, 23 articles were included. Two reviewers independently extracted the data from the studies and summarized them in a table. Eleven of twenty-three studies evaluated the effect of radiofrequency ablation (RFA), 5 evaluated occipital nerve blocks, 2 each for facet joint injections and deep cervical plexus blocks, and 1 study each evaluated atlantoaxial (AA) joint injections, cervical epidural injection, and cryoneurolysis. Most of the studies reported pain reduction except 2 studies on RFA. In conclusion, based on the available literature, occipital nerve blocks, cervical facet joint injection, AA joint injection, deep cervical plexus block, cervical epidural injection may be reasonable options in refractory cases of CeH. RFA was found to have favorable long-term outcomes, while better safety has been reported with pulsed therapy. However, our review revealed only limited evidence, and more randomized controlled trials are needed to provide more conclusive evidence.

Effects of Occipital Nerve Block in Pediatric Patients with Occipital Region Headache

Purpose: The aim of this study was to investigate the effects of occipital nerve block (ONB) in pediatric patients with headache in the occipital region.Methods: Among 302 patients who visited our headache clinic during a 2-year period, we retrospectively reviewed the charts of 26 patients who complained of primary headache in the occipital region, and divided them into two groups according to the main treatment: ONB or oral drug treatment (ODT).Results: The mean age of the 26 patients was 11.7±3.2 years. No statistically significant differences were found between the ONB and ODT groups in age, sex, sites of pain, duration of having experienced symptoms, and the duration, frequency, and severity of episodes (P>0.05). There was no statistically significant difference in remission between the ONB and ODT groups. However, in the ONB group, the time taken to achieve remission was significantly shorter than in the ODT group (P<0.05). Additionally, in the ONB group, the duration of medication and the period of outpatient treatment were significantly shorter than in the ODT group (P<0.05).Conclusion: In this study, ONB reduced the time taken to achieve remission and shortened the period of treatment. Thus, ONB should be considered in pediatric patients with headache in the occipital region.

Postural physiotherapy for cervicogenic headache after occipital nerve block: a retrospective study

Cervicogenic headache has a complex and poorly understood pathophysiology. Symptoms are typical and involve the C2 and C3 nerve roots. There are no specific recommendations for physical therapy, although occipital nerve block is a known pharmacological treatment. Some evidence suggests that hip rotation correction could aid in reducing cervical pain symptoms. The objective of this work is to evaluated the role of postural physiotherapy for hip rotation correction using the Maitland technique in patients with cervicogenic headache who underwent an occipital nerve block. In this retrospective, observational and uncontrolled study, patients were evaluated from January 2017 to February 2018. After diagnosis of cervicogenic headache they underwent anesthetic block, hip radiography with lower limb scanometry and cervical tomography, after which they were referred to physical therapy. The analog pain scale was used for evaluation at the time of diagnosis and after the proposed physiotherapy. Patients submitted to an occipital nerve block were divided into three groups: Group I (n = 15, physical therapy with Maitland technique) had an analog pain score of 1.6 after the physical therapy, Group II (n = 11, conventional physiotherapy) had an analog pain score of 3.7 after the physical therapy and Group III (n = 13, occipital nerve block only) had an analog pain score of 5.2 after the occipital nerve block. The results suggest that an occipital nerve block in combination with the Maitland technique is superior in patients with cervicogenic headache compared to nerve block only or blockade combined with non-specific physical therapy (p=0,013).

Correlates of post-dural puncture headache and efficacy of different treatment options: a monocentric retrospective study.

Post-dural puncture headache (PDPH) is a severe positional headache that appears usually within 72 hours after inadvertent dural puncture, secondary to cerebrospinal fluid leakage. It is treated first by conservative treatment (including bed rest, hydration, caffeine and simple analgesia) and then by invasive procedures such as blood patch. This study aims to evaluate factors associated with PDPH among a sample of Lebanese patients and assess the rate of success of different treatment modalities administered in a specific sequence: conservative treatment first, then ultrasound-guided bilateral greater occipital nerve block (GONB) if failure of conservative treatment and finally epidural blood patch (EBP) if failure of GONB. A retrospective case-control study was conducted between January 2015 and December 2019 in the Notre-Dame des Secours University Hospital. Out of a total of 10,051 procedures, 18 cases were diagnosed with PDPH and were matched based on gender, age and procedure type to a control group of patients who did not develop PDPH randomly selected (72 patients). Higher body mass index (adjusted odds ratio (ORa) = 0.77) was significantly associated with lower odds of PDPH, whereas the presence of previous chronic headache (ORa = 5.56) was significantly associated with higher odds of PDPH. Seven out of 18 (38.89%) had their pain symptoms/headache resolved on conservative treatment. Out of the remaining 11 patients, 6 (33.33%) had their symptoms resolved on GONB with a significant decrease in the pain score 48 hours after GONB compared to baseline (5.55 vs 9.73; p = 0.007). Five patients (27.78%) had their symptoms resolved using a blood patch, with a significant decrease in the pain score after blood patch compared to baseline (3.00 vs 9.80; p = 0.041). Our preliminary data suggest that ultrasound-guided GONB is a minimally risky and efficacious technique for those who fail to respond to conservative treatment.

Regional cerebral blood flow as predictor of response to occipital nerve block in cluster headache

BackgroundCluster headache is an excruciating disorder with no cure. Greater occipital nerve blockades can transiently suppress attacks in approximately 50% of patients, however, its mechanism of action remains uncertain, and there are no reliable predictors of treatment response. To address this, we investigated the effect of occipital nerve blockade on regional cerebral blood flow (rCBF), an index of brain activity, and differences between treatment responders and non-responders. Finally, we compared baseline perfusion maps from patients to a matched group of healthy controls.Methods21 male, treatment-naive patients were recruited while in a cluster headache bout. During a pain-free phase between headaches, patients underwent pseudo-continuous arterial spin labelled MRI assessments to provide quantitative indices of rCBF. MRIs were performed prior to and 7-to-21 days following treatment. Patients also recorded the frequency of their headache attacks in a daily paper diary. Neuropsychological assessment including anxiety, depression and quality of life measures was performed in a first, scanning free session for each patient.ResultsFollowing treatment, patients demonstrated relative rCBF reductions in posterior temporal gyrus, cerebellum and caudate, and rCBF increases in occipital cortex. Responders demonstrated relative rCBF increases, compared to non-responders, in medial prefrontal cortex and lateral occipital cortex at baseline, but relative reductions in cingulate and middle temporal cortices. rCBF was increased in patients compared to healthy controls in cerebellum and hippocampus, but reduced in orbitofrontal cortex, insula and middle temporal gyrus.ConclusionsWe provide new mechanistic insights regarding the aetiology of cluster headache, the mechanisms of action of occipital nerve blockades and potential predictors of treatment response. Future investigation should determine whether observed effects are reproducible and extend to other headache disorders.

Percutaneous Interventional Strategies for Migraine Prevention: A Systematic Review and Practice Guideline.

To systematically evaluate the efficacy and effectiveness of percutaneous interventional treatments for prevention of migraine through a qualitative and (when possible) quantitative analysis. 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 by using the Grading of Recommendations, Assessment, Development and Evaluations (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. The committee screened 1,195 studies and assessed 352 by full text, yielding 16 randomized controlled trials that met the inclusion criteria. 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 its use for chronic migraine prevention and a weak recommendation against its use for episodic migraine prevention. Greater occipital nerve blocks received a weak recommendation for their use for chronic migraine prevention. For greater occipital nerve block, steroid received a weak recommendation against its use vs the use of local anesthetic alone. Occipital nerve with supraorbital nerve blocks, sphenopalatine ganglion blocks, cervical spine percutaneous interventions, and implantable stimulation all received weak recommendations for their use for chronic migraine prevention. The committee found insufficient evidence to assess trigger point injections in migraine prevention and highly discouraged the use of intrathecal medication.

Greater occipital nerve block modulates nociceptive signals within the trigeminocervical complex

IntroductionThe pharmacological block of the greater occipital nerve has been proven effective in numerous headache and facial pain syndromes. This clinical effect supports the hypothesis of a strong functional interaction...

Occipital Neuralgia.

Occipital neuralgia is a painful condition that affects the posterior aspect of the head and can be difficult to distinguish from other common forms of headaches. This article reviews the anatomy, pathophysiology, clinical presentation, differential diagnosis, diagnostic testing, and management approaches for occipital neuralgia. Non-pharmacological treatments aim to alleviate muscle tension and improve posture. Acupuncture shows some promise. The occipital nerve block is considered the first line in a minimally invasive intervention, but the duration of relief may be short term. An onabotulinum toxin A injection may improve the sharp but not the dull component of the pain of occipital neuralgia. Radiofrequency ablation and occipital nerve stimulation may provide effective long-term relief in refractory patients. Surgical decompression, neurotomies, and neurolysis are last-resort treatment options. Occipital neuralgia is a debilitating condition that can be difficult to treat. Studies with larger sample sizes and randomized control trials are needed to further determine the effectiveness and safety of different therapies.

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.

Sphenopalatine Ganglion versus Greater Occipital Nerve Blocks in Treating Post-Dural Puncture Headache after Spinal Anesthesia for Cesarean Section: A Randomized Clinical Trial

Despite being invasive, with serious complications, epidural blood patch (EBP) is still considered the gold standard therapy for Post Dural Puncture Headache (PDPH). The use of Peripheral nerve blocks for PDPH are studied here. To investigate the efficacy of sphenopalatine ganglion block (SPGB) and greater occipital nerve block (GONB) to relieve PDPH and its associated symptoms. Randomized comparative single-blind trial. A University hospital. Patients who received spinal anesthesia for elective cesarean section, and then developed PDPH during hospitalization or within 5 days after dural puncture were enrolled to receive GONB (n = 47) or SPGB (n = 46) for treatment of PDPH. GONB Group: Patients received bilateral GONB using 3 mL mixture of 2 mL lidocaine 2% plus 1 mL dexamethasone 4 mg on each side of occipital region. SPGB Group: Patients received bilateral SPGB using the same mixture in each nostril. Assessments included Numeric Rating Scale (NRS) for severity of headache at supine and sitting positions, nausea NRS, neck stiffness, need for EBP, and complications. The supine and sitting headache NRS scores significantly decreased at 30 minutes after blocks and throughout follow-up period in both groups (P < 0.000). Clinically significant drop of NRS to < 4 was reached earlier in GONB group. There was a significant difference between groups after 2 hours in supine and sitting headache NRS scores (P = 0.020 and 0.030, respectively); however, both treatments showed similar effectiveness from the third hour afterwards (P > 0.05). Both techniques were effective in relieving neck stiffness and nausea (P < 0.000), with no adverse effects. A limitation to this study was the small sample size. GONB and SPGB are equally effective in relieving symptoms of PDPH. Both techniques are safe, simple, and less invasive than EBP.

Comparison of greater occipital nerve and greater occipital nerve + supraorbital nerve block effect in chronic medication overuse headache

Background /aimIn this study, we aimed to compare the efficacy of greater occipital nerve (GON) block alone and GON combined with supraorbital nerve (SON) block in the treatment of medication overuse headache (MOH).Material and methods82 patients were divided into two groups: 41 patients were administered bilateral GON block while the other 41 patients GON + SON block. Nerve blocks were administered every 10 days for a total of 5 sessions. After each administration and 20 days after the last injection, information on pre and post treatment numerical rating scale (NRS) score, number of painful days, analgesic intake, duration of pain were collected.ResultsThe decrease in headache evaluation parameters was similar in both groups after the block. The NRS scores in the GON and GON + SON groups before the treatment was (8.2 ± 0.7, 8.5 ± 0.7), the number of painful days in a month was (21.4 ± 6.9, 21.2 ± 4.6 days), the number of analgesics taken monthly was (45 ± 25.6, 47.5 ± 29.9), the duration of pain was (44.9 ± 24.6, 41.7 ± 22.8 h), respectively. On the 60th day of treatment, the NRS scores in the GON and GON + SON groups were found to be (6.8 ± 2.5, 4.8 ± 2.3), the number of painful days in a month was (4.2 ± 3.3, 2.2 ± 1.5), respectively. The number of monthly nalgesic consumption was (4.4 ± 3.8, 0.9 ± 1.2), and the duration of pain was (28.4 ± 19.3, 19.4 ± 16.1 h).ConclusionThis study showed significant reductions in headache parameters in both groups. However, NRS score, analgesic intake, number of painful days, and pain duration significantly better improved in the GON block added SON block group.

Clinic-based Procedures for Headache.

Headache disorders are common and disabling, and many therapies that are effective and safe are procedural. After pivotal clinical trials, onabotulinumtoxinA has become an established preventive therapy for chronic migraine; it is better tolerated than many other treatments and may be useful for other headache disorders. Peripheral nerve blocks, especially greater occipital nerve blocks, have amassed evidence from randomized trials in the acute and short-term preventive treatment of migraine and cluster headache. Trigger point injections and sphenopalatine ganglion blocks have recent trials suggesting efficacy and safety in properly selected patients. Medical education initiatives are needed to train neurologists in these procedures to help manage the large population of patients with headache disorders who need them. Evidence exists for the efficacy and safety of procedural therapies to be incorporated into neurology practice for the management of patients with migraine, cluster headache, and other headache disorders.

Effects of greater occipital nerve block with local anesthetic and triamcinolone for treatment of medication overuse headache: an open-label, parallel, randomized, controlled clinical trial.

There is a paucity of evidence and consensus on exactly how to carry out the detoxification process. To examine the effect of a greater occipital nerve block (GONB) in the detoxification process, we conducted an open-label, parallel, randomized, controlled clinical trial. In order to conduct this study, 54 medication-overuse headache (MOH) patients were recruited and allocated randomly to group A (n = 27) or B (n = 27). In both groups, patients underwent detoxification processes without any acute migraine medication or analgesics. During the run-in period, all patients in both groups received the same education, managed by a neurologist and nutritionist. All patients were offered maximally 300 mL of promethazine syrup (5 mg/5 mL) to be taken 10 mg every 8 h during the first 10 days of the study. A 2-mL syringe containing 1 mL of lidocaine 2% and 1 mL of triamcinolone 40 mg/mL was prepared for each patient of group A for conducting GONB. Characteristics of headache attacks, including headache severity, frequency, and duration, were assessed at baseline and after 3 months of intervention. Twenty-six patients in group A (96.3%) and twenty-three in group B (85.2%) completed detoxification, and were thus cured of MOH (P = 0.351). The present study revealed that GONB with local anesthetic and triamcinolone significantly improved the characteristics of headache, including frequency (- 13.66 in group A and - 7.55 in group B), duration (- 7.92 in group A and - 5.88 in group B), and severity (- 3.44 in group A vs. - 1.33 in group B) in group A compared to control (all P value < 0.05). Although both detoxification programs were effective, detoxification with GONB resulted in better outcomes. Iranian Registry of Clinical Trials (registration number; IRCT20150906023922N2).

Effectiveness of Bilateral Greater and Lesser Occipital Nerve Blocks in the Prophylaxis of Episodic Migraine

Aim: In recent years, many studies have been conducted on the effectiveness of occipital nerve block (ONB) especially in the prophylaxis of chronic migraine. In this study, it was aimed to investigate the effectiveness of bilateral greater and lesser ONBs in the prophylaxis of episodic migraine without aura. Material and Methods: This retrospective study included patients with episodic migraine without aura who underwent bilateral greater and lesser ONBs between January 2018 and December 2019. Information about headache frequency, attack duration, and pain severity (VAS score) of the patients in the last month before nerve block and 1 month after nerve block was retrieved from the database and recorded for statistical analysis. Results: A total of 17 patients aged 26-57 years were included in this study. None of the patients developed any drug side effects or complications associated with ONB. With ONB, the median value of headache attack frequency dropped from 5 (range, 4-14) to 2 (range, 0-6) per month (p=0.001), the median value of pain duration dropped from 12 (range, 6-14) to 4 (range, 0-9) days (p&amp;lt;0.001), and the median value of VAS pain severity score dropped from 9 (range, 7-10) to 5 (range, 0-10) for the patients (p=0.001), compared with the pretreatment values. Conclusion: Bilateral greater and lesser ONBs are effective in the prophylaxis of episodic migraine without aura. ONB can be considered as a treatment option in patients with episodic migraine without aura who do not respond to conventional treatments (oral drugs) or do not accept conventional therapy.

Facial Nerve Palsy After Occipital Nerve Blocks — A Case Report

The use of bupivacaine and other local anesthetics to perform peripheral nerve blocks is a mainstay in the management of refractory headaches and migraines. In this case report, a patient presented with transient facial nerve palsy shortly after receiving occipital nerve blocks for headaches. Patient’s symptoms self-resolved, and her symptoms were thought to be due to displacement and spreading of bupivacaine to the facial nerve. The spread of bupivacaine can be facilitated by tracking across fascial planes or nerve sheaths. Similar side effects have been seen in dental anesthesia, but there has only been one other report of such a presentation associated with occipital nerve blocks, and none in pediatric patients. Physicians should be aware of this rare complication with peripheral nerve blocks.

OUTCOME OF OCCIPITAL NERVE BLOCK IN PATIENTS WITH CHRONIC HEADACHES

Background: Chronic headaches are very prevalent affecting a sizable number of global populations. Occipital nerve block (OCN) can help them relieve their pain and get back to their normal life. Conditions that are treated with occipital nerve blocks include: Chronic migraine, Episodic migraine, Chronic cluster headaches, Episodic cluster headaches, Tension-type headaches, Occipital neuralgia. These may include types of pain that start at the back of the head near the neck, and then radiate outward throughout the skull. Occipital nerve block is a minimally invasive intervention, inhibits or blocks the disproportionate or chronic signals that are sent to the brain, processed and perceived as headache pain, resulting in pain relief lasting up to several months. It is our humble approach to see the effectiveness of this mode of minimal intervention. Objectives: The aim was to see the effectiveness of Occipital Nerve Block in patients of Chronic headaches. Place of study: Dept of PMR, IPGME &amp; R and SSKM Hospital, Kolkata Period of study: 1 st. September, 2017 to 31 st. August, 2018. (12 months) Study pattern: Prospective Longitudinal Outcome Study Methods: After getting Institutional Ethical Committee clearance a total number of 98 patients with Chronic headaches who did not respond with conservative management were included. Patients with other causes of headache, patients with diabetes, severe hypertension, otherwise th th th contraindicated for injections, are excluded. Occipital nerve blocks performed to patients and were evaluated initially and at the 4 , 8 , and 12 week followed up using Numeric Pain Rating Scale (NPRS). Adverse events and patient satisfaction were recorded, number of attacks pre 4wks and after intervention. Results: Statistically signicant improvement is seen in these patients treated with Occipital Nerve Block Conclusions: Occipital Nerve Block effective mode of management in patients with Chronic headaches and may be recommended to patients with moderate to severe chronic pain that has not responded to conventional treatment such as oral painkillers or lifestyle interventions.

Efficacy and safety of greater occipital nerve block for the treatment of cervicogenic headache: a systematic review

ABSTRACT Introduction Cervicogenic headache (CGH) is a secondary headache disorder caused by cervical spine or neck soft tissue lesions. Despite few available evidence-based pharmacological treatments are available, greater occipital nerve blocks (GONBs) are considered as therapeutic option. Area covered In June 2020, we conducted a systematic review on Pubmed and Scopus, to summarize effectiveness and safety of GONBs in treating CGH. We included 5 observational studies and 3 nonrandomized trials reporting clinical outcomes of 140 CGH patients after GONBs. Authors performed unilateral GONBs during interictal phase (five studies) or during pain, injecting local anesthetic (four studies) or both local anesthetic and steroid (three studies) at variable timepoints. In 5 studies mean pain reduction ranged from −8.2 (at 2 weeks after the first block) to −0.1 (at 1 month after the third block); one study documented 66.6% reduction of pain intensity and another study documented a significant median reduction of pain intensity at 3 months (decreased from 5.5 to 2.3) and not at 9 months. Three studies reported minor adverse events. Expert opinion Few available studies suggest that GONBs are effective and safe in treating CGH. GONB is a high tolerable, low cost and repeatable procedure. Larger and randomized studies are needed.