Occipital Nerve Research Articles

Current and Novel Therapies for Cluster Headache: A Narrative Review.

Cluster headache (CH) is an excruciating and debilitating primary headache disorder. The prevalence is up to 1.3%, and the typical onset is around age 30. Often misdiagnosed as migraine, particularly in children, the diagnosis rate of CH has been increasing among women. CH is characterized by intense unilateral pain and autonomic symptoms, significantly impacting patients' quality of life, mental health, and productivity.Genetic associations suggest a familial risk for developing CH, with lifestyle factors also potentially playing a role. The pathophysiology involves alterations in both central and peripheral nervous system, with the hypothalamus, trigeminocervical complex, and neuropeptides such as calcitonin gene-related peptide (CGRP) being implicated.Nonpharmacological treatments focus on patient education and lifestyle modifications, while pharmacological treatments include acute therapies such as oxygen and subcutaneous or nasal sumatriptan, as well as preventive therapies like verapamil, lithium, and CGRP monoclonal antibodies. Transitional options include oral corticosteroids and greater occipital nerve injections. Emerging interventional procedures offer new avenues for managing refractory cases. Noninvasive vagal nerve stimulation and occipital nerve stimulation show promise for both acute and preventive treatment. Careful consideration of safety profiles is crucial in specific populations such as pregnant patients and children.Current treatments still leave patients highly burdened by limited efficacy and side effects. Future research continues to explore novel pharmacological targets, interventional procedures, and the potential role of psychedelics in CH management. Comprehensive, multifaceted treatment strategies are essential to improve the daily functioning and quality of life for individuals with CH.

Extent of Pain Distribution in Entrapment of the Greater Occipital Nerve Identified Through Skin Lesions of Herpes Zoster Involving the Greater Occipital Nerve

Herpes zoster (HZ) involving the upper cervical nerves (C2-C4), which innervate the posterior head, is rare. There have also been few reports of HZ lesions involving the greater occipital nerve (GON), which refers to the medial branch of the dorsal ramus of the second cervical nerve. Pain due to GON entrapment radiates not only to the temporo-occipital region, but also to the ear, retro-auricular and sub-auricular areas of the neck, the angle of the jaw, and the posterolateral neck. Herein, we present the case of a patient who underwent decompression surgery for referred trigeminal pain due to GON entrapment and who developed HZ one week later. Skin lesions of HZ involving the GON occurred not only in the occipital area but also in the ipsilateral ear, auricle, posterior and anterolateral neck. This case of HZ involved all cutaneous areas innervated by the C2, C3, and C4 spinal nerves. The extent of the skin lesions indicated where the pain from the GON radiated.

C0-C1 joint injection: Anatomical, clinical and technical review

BackgroundCervicogenic headaches (CGH) are proven clinical entities. The prevalence of CGH arising from the atlanto-occipital (AO) joint is unknown. The best evidence for treatment of CGH is for third occipital nerve radiofrequency neurotomy. Treatment of CGH includes intra-articular injections into upper cervical spine joints. ObjectiveTo perform a review of the anatomy and clinical presentation of AO joint (AOJ) pain referral as well as a technical description to safely access the AOJ. MethodsA literature review was performed to explore the intricacies of the cranio-cervical junction (CCJ) with a focus on the relation between the AOJ and vascular anatomy. Our technical approach is described with complementary images. ResultsThe AOJ lies anterior to a venous sinus and slightly superior to the horizontally oriented vertebral artery crossing the joint line. ConclusionThe authors propose a modified superior needle trajectory that seeks to avoid these vascular structures and to access the AOJ safely.

Bilateral Greater Occipital Nerve Block for Preventing the OnabotulinumtoxinA Wear-off Phenomenon in the Treatment of Chronic Migraine: A Case Series of 12 Patients

Purpose: OnabotulinumtoxinA is widely used to treat chronic migraines; however, the wear-off phenomenon before the next scheduled dose has emerged as a challenge. This study suggests a new strategy for preventing the wear-off phenomenon using bilateral greater occipital nerve block. Methods: We conducted a retrospective review of patients diagnosed with chronic migraine who were treated with onabotulinumtoxinA and bilateral greater occipital nerve block at St. Vincent Hospital from January 2023 to December 2023. Twelve chronic migraine patients with a history of the wear-off phenomenon received a greater occipital nerve block 8 weeks after the initial onabotulinumtoxinA injection for two sessions. Responses to treatment were evaluated with regular follow-ups and daily headache diaries. Results: All patients who had previously experienced the wear-off phenomenon with conventional onabotulinumtoxinA treatment did not experience the wear-off phenomenon during two sessions with an additional greater occipital nerve block administered 8 weeks after each onabolulinumtoxinA injection. Conclusion: Bilateral greater occipital nerve block administered 8 weeks after the initial onabotulinumtoxinA injection effectively prevents the wear-off phenomenon, enabling sustained therapeutic benefits in chronic migraine patients. Further research is needed to confirm these findings in larger cohorts.

A novel technique to identify and thermally ablate the greater occipital nerve for patients with occipital neuralgia: a retrospective study with cadaveric and ex-vivo validation.

This manuscript presents the challenges of treating various forms of headaches and the potential of interventional techniques targeting the greater occipital nerve (GON) to alleviate the burden on patients. Occipital neuralgia, characterized by stabbing or shooting pain in the base of the skull, is often associated with primary, cervicogenic, or migraine headaches. While occipital nerve blocks offer temporary relief, durable treatment options are limited. Pulsed radiofrequency (PRF) and thermal radiofrequency ablation (TRFA) have shown promise as minimally invasive procedures for long-term treatment. However, GON is not easily identified using ultrasound or fluoroscopic analysis; thereby, minimizing success of proper ablation. Here, the authors provide a percutaneous strategy to localize the GON and maximize lesion performance. We intend to provide an ex-vivo description of staggered bipolar radiofrequency (RF) lesioning and include the use of staggered bipolar lesioning of the GON and stimulation of the semispinalis capitis. We also analyzed the effectiveness and side effects from this ablation, retrospectively. Patients with chronic refractory GON neuralgia were selected for GON TRFA. A novel double needle technique of sequential electrical stimulation was used to localize the GON and approximate needle to nerve distance. Once the needles were positioned adjacent to the GON, TRFA was performed using a bipolar staggered technique. Twenty-two patients with GON were treated with TRFA using a novel double needle technique. Seventy-two percent of these patients reported greater than 50% pain relief at both 1 and 6 months following the procedure. The results of our ex-vivo study demonstrate that performing TRFA using the parallel needle bipolar approach separated 8 mm apart produced the most desirable lesion dimensions that may correlate with effective ablation of the GON. This study demonstrates a new localization and ablation technique to treat refractory headaches. However, larger studies are needed to confirm our findings.

Influence of greater occipital nerve block on the relief of acute migraine: A meta-analysis.

Greater occipital nerve (GON) block may help relieve acute migraine, and this meta-analysis aimed to investigate the influence of GON block on pain relief of acute migraine. We systematically searched PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases, and included randomized controlled trials (RCTs) assessing the efficacy of GON block for acute migraine. Meta-analysis was performed using the random-effect model regardless of the heterogeneity. Four RCTs and 224 patients were included in the meta-analysis. Compared with control intervention in acute migraine, GON block intervention could significantly reduce pain scores at 45 to 60 minutes (MD = -2.31; 95% CI = -3.08 to -1.53; P < .00001) and pain scores at 30 minutes (MD = -1.95; 95% CI = -2.61 to -1.29; P < .00001), but demonstrated no impact on pain scores at 0 to 15 minutes (MD = -0.46; 95% CI = -1.00 to 0.08; P = .09), sustained headache relief (OR = 1.46; 95% CI = 0.06-36.66; P = .82) or rescue medication (OR = 0.32; 95% CI = 0.01-19.16; P = .59). GON block intervention may be able to alleviate pain intensity for acute migraine patients.

When Should Headache Specialists Hold a Needle? The Role of Botulinum Toxin Injections and Occipital Nerve Blocks

When Should Headache Specialists Hold a Needle? The Role of Botulinum Toxin Injections and Occipital Nerve Blocks

Post Dural Puncture Headache After Spinal Cord Stimulator Lead Insertion Successfully Treated with Occipital Nerve Blocks

Post Dural Puncture Headache After Spinal Cord Stimulator Lead Insertion Successfully Treated with Occipital Nerve Blocks

Genotypes and phenotypes of capillary malformation-arteriovenous malformation: characterization and correlation analysis.

Capillary malformation-arteriovenous malformation (CM-AVM) is a rare genetic disorder characterized by multiple small capillary malformations (CMs) and arteriovenous malformations (AVMs), which has been linked with pathogenic variants in RASA1 and EPHB4. However, more data are needed to explore the phenotypic characteristics and the association between genotypes and clinical phenotypes. Our aim was to investigate the phenotypic and genetic characteristics of CM-AVM in East Asians, identify potential unique phenotypes, and conduct genotype-phenotype association analyses. This is a single-center study prospectively collecting CM-AVM patients' clinical data, with genetic data from blood or tissue samples. A total of 59 patients were enrolled. Thirty-two individuals had a leading CM greater than Schobinger stage II. The trigeminal nerve branches and greater auricular, transverse cervical, and lesser occipital nerves' somatosensory innervation zones divided head and neck CMs into six zones: V1, V2, V3, GA, TC, and LO zones. GA, TC, and LO zones had a positive correlation with one another but a negative correlation with V2 zone involvement. The RASA1 and EPHB4 pathogenic variants were detected in 41 out of 59, which showed two types of variant allele frequency (VAF) distributions. VAF above 30% made RASA1 pathogenic variants more susceptible to multifocal CMs than those below 30%. Leading CMs in the head and neck exhibit two segmentation patterns, anterior and lateral, which may differ in ear involvement and progression. Germline RASA1 pathogenic variants increased multifocal CM risk more than the somatic variants.

ID: 317303 Atypical headache and facial pain treated with a unilateral dual lead peripheral occipital nerve stimulator

ID: 317303 Atypical headache and facial pain treated with a unilateral dual lead peripheral occipital nerve stimulator

ANODYNE study: A double-blind randomized trial of greater occipital nerve block of methylprednisolone and lignocaine versus placebo as a transitional preventive treatment for episodic cluster headache.

There is inadequate evidence of the efficacy of greater occipital nerve block (GONB) for the preventive treatment of cluster headaches. We assessed the efficacy and tolerability of GONB injections as a transitional preventive treatment for episodic cluster headaches (ECH). This randomized, double-blind, placebo-controlled, parallel-group trial conducted at GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India, included ECH patients diagnosed by ICHD-3 criteria, aged 18-65, with one or more attacks per 24 h for seven days before randomization (baseline). ECH patients were either not on preventive medications or on stable doses for at least three months. ECH patients were randomized to receive active GONB (2 ml methylprednisolone (80 mg) and 2 ml lignocaine (2%)) and placebo (4 ml saline injections). Before giving GONB, lignocaine jelly was applied topically to mask the effect of numbness following the GONB. The primary efficacy endpoint was the mean change in weekly attack frequency from baseline to Week 4. Efficacy analyses were performed in a modified intention-to-treat population that included all patients who received at least one injection of GONB and had a follow-up for one week following GONB. The safety analysis included treatment-emergent adverse effects (TEAE) in all patients who received at least one dose of investigational product. The trial was registered with the Clinical Trials Registry of India (CTRI/2021/21/038397). Forty ECH patients were randomized between December 2021 and January 2023. Thirty-nine patients (19 in the active and 20 in the placebo groups) were available for efficacy analysis. The change in weekly attack frequency from baseline to Week 4 was -11.1 (95% CI: -8.5 to -4.4) for the active group compared to -7.7 (95% CI: -11.8 to -9.8) for placebo (mean difference -3.4 (95% CI: -5.2 to -1.7, p < 0.001). We noted TEAE in 18 (90%) of 20 patients who received the active drug and in 18 (90%) of 20 patients who received a placebo (p = 0.38). The common TEAE were local site bleeding and pain, which were mild and transient. No serious adverse events were reported. This study found that GONB with methylprednisolone and lignocaine significantly reduced the weekly attack frequency from baseline to Week 1 through Week 4 in ECH patients compared to a placebo. GONB was well tolerated.

ID: 332285 Central Sensitisation Response following Occipital Nerve Stimulation: 9-year follow-up

ID: 332285 Central Sensitisation Response following Occipital Nerve Stimulation: 9-year follow-up

ID: 325457 Combined Occipital Nerve and Cervical Spinal Stimulators for Treatment of Post-Lyme Occipital and Trigeminal Neuralgias

ID: 325457 Combined Occipital Nerve and Cervical Spinal Stimulators for Treatment of Post-Lyme Occipital and Trigeminal Neuralgias

Four Decades of OccipitalNerveStimulation for Headache Disorders: A Systematic Review.

Chronic headaches are a significant source of disability worldwide. Despite the development of conventional strategies, a subset of patients remain refractory and/or experience side effects following these treatments. Hence, occipital nerve stimulation (ONS) should be considered as an alternative strategy for intractable chronic headaches. This review aims toprovidea comprehensive overview of the effectiveness, safety, mechanisms and practical application ofONSfor the treatment of headache disorders. Overall response rate of ONS is 35.7-100%, 17-100%, and 63-100% in patients with cluster headache, chronic migraine and occipital neuralgia respectively. Regarding the long-term effectivity in all groups, 41.6-88.0% of patients remain responders after ≥ 18.3months. The most frequently reported adverse events include lead migration/fracture (13%) and local pain (7.3%). Based on our results, ONS can be considered a safe and effective treatment for chronic intractable headache disorders. To support more widespread application of ONS, additional research with larger sample sizes should be conducted.

Fish That Fish for Fish-A Peculiar Location of "Fishing Motoneurons" in the Striated Frogfish Antennarius striatus.

In lophiform teleosts, the first dorsal fin has evolved as a specialized structure called the "illicium" equipped with the esca, which is a modified skin flap used to attract small fish for predation. The motor control system of the illicium, however, remained unknown. The present study investigated the innervation of muscles for the illicium and morphology of motoneurons innervating them in the striated frogfish Antennarius striatus. We found that the dorsal ramus of occipital nerve innervates the muscles. Motoneurons for the illicium are present in the dorsolateral zone of ventral horn at the medullo-spinal boundary level, forming a cluster somewhat distinct from other motoneurons of the ventral horn. Motoneurons for the second to fourth dorsal fins and pectoral fin were located in the ventrolateral and ventromedial zones of ventral horn, respectively, whereas those of the dorsal trunk muscle in the dorsomedial zone of ventral horn. Motoneurons for the first dorsal spine of white-spotted pygmy filefish were also investigated for species comparison and were found to locate in the ventrolateral zone of ventral horn, similarly to the motoneurons for the second to fourth dorsal fins of the frogfish. These results suggest that motoneurons for the illicium have become segregated from other motoneurons to be situated in an unusual dorsal position for a motoneuron pool of a dorsal fin, in concert with the evolution of specialized "fishing behavior" performed by the illicium.

Excision of Giant Occipital-Lateral Neck Lipoma with Ultrasound Guided Superficial Cervical Plexus Block Combined with Greater Occipital Nerve Block

Excision of Giant Occipital-Lateral Neck Lipoma with Ultrasound Guided Superficial Cervical Plexus Block Combined with Greater Occipital Nerve Block

Assessing the reliability and readability of migraine treatment information on Turkish websites

BackgroundThe quality and safety of information provided on online platforms for migraine treatment remains uncertain. We evaluated the top 10 trending websites accessed annually by Turkish patients seeking solutions for migraine treatment and assessed information quality, security, and readability in this cross-sectional study.MethodsA comprehensive search strategy was conducted using Google starting in 2015, considering Türkiye’s internet usage trends. Websites were evaluated using the DISCERN measurement tool and Ateşman Turkish readability index.ResultsNinety websites were evaluated between 2015 and 2024. According to the DISCERN measurement tool, most websites exhibited low quality and security levels. Readability analysis showed that half of the websites were understandable by readers with 9th − 10th grade educational levels. The author distribution varied, with neurologists being the most common. A significant proportion of the websites were for profit. Treatment of attacks and preventive measures were frequently mentioned, but some important treatments, such as greater occipital nerve blockade, were rarely discussed.ConclusionThis study highlights the low quality and reliability of online information websites on migraine treatment in Türkiye. These websites’ readability level remains a concern, potentially hindering patients’ access to accurate information. This can be a barrier to migraine care for both patients with migraine and the physician. Better supervision and cooperation with reputable medical associations are needed to ensure the dissemination of reliable information to the public.

Management of migraine by hospital emergency departments: a retrospective observational study carried out at the Hospital Universitario Virgen del Rocio

Migraine is the second most common type of primary headache disorder in Europe, accounting for 2.8% of visits to emergency departments. Some studies have shown that emergency departments may approach the disorder in ways that may be insufficient or inadequate. A retrospective observational study was conducted of patients with migraine who were discharged from the adult emergency department of the Hospital Universitario Virgen del Rocio in 2020. Variables related to their healthcare were analysed. 73.9% were women, with a mean age of 38 years. They were not asked about the frequency of their migraines. The mean length of time patients spent in the emergency department before receiving initial medical care was 45 minutes (standard deviation: 41). Computed tomography scans were requested for 27.4% of the patients, and these were not pathological. Nonsteroidal anti-inflammatory drugs were the most commonly used treatment for the symptoms. Opioids were also used. Preventive treatments were prescribed in 6% of cases. Management of migraines by emergency departments is limited, and as such continuous and updated training is important. The use of triptans and occipital nerve blocks should be encouraged, and the use of opioids, among other drugs, should cease.

Minimally Invasive Surgical Decompression of Occipital Nerves.

Occipital neuralgia (ON) stands out as one of the most distressing forms of headache disorders, distinguished by persistent pain at the base of the skull, recurring occipital headaches, and scalp dysesthesia or allodynia. ON is notorious for its unrelenting agony, severely impacting the lives of those afflicted. The incessant pain, often radiating upward from the base of the skull to the scalp, can be profoundly debilitating. Patients frequently endure excruciating occipital headaches, making even routine daily activities a formidable challenge. The added burden of scalp dysesthesia or allodynia, where seemingly innocuous stimuli elicit severe pain, compounds the suffering. This neuralgia primarily arises from the mechanical compression exerted on the occipital nerves along the nuchal line. In this paper, we present a minimally invasive nerve and muscle-preserving technique aimed at relieving this compression on the occipital nerves. Accurate diagnosis and effective treatment are paramount in providing relief for individuals battling this condition. Nerve blocks with local anesthesia have become a cornerstone of diagnosis, serving as both a confirmation of occipital neuralgia and a potential therapeutic intervention. These procedures offer crucial insights into the source of the pain while offering transient respite. However, the true breakthrough lies in the innovative technique we propose - a procedure that addresses the mechanical compression at the nuchal line, which is a prominent contributing factor to occipital neuralgia. By carefully decompressing the affected occipital nerves while preserving their integrity and surrounding muscle tissue, this minimally invasive approach offers patients a potential path to sustained relief. Remarkably, the procedure can be performed under local anesthesia, reducing the invasiveness of traditional surgeries and minimizing patient downtime.

Effectiveness of combining greater occipital nerve block and pulsed radiofrequency treatment in patients with chronic migraine: a double-blind, randomized controlled trial

BackgroundPulsed radiofrequency (PRF) treatment targeting the greater occipital nerve (GON) has shown efficacy in treating various conditions. This double-blind, randomized controlled study aimed to evaluate the effects of combining PRF therapy with GON block (GONB) therapy in patients with chronic migraine.MethodsThe study consisted of two groups: GONB and GONB + PRF, each comprising 16 patients with chronic migraine. Using 0.5-Hz sensorial stimulation, a 5-cm-long radiofrequency needle was inserted under ultrasound guidance in both groups. Subsequently, all patients received a GONB by administering 2 mL of 0.25% bupivacaine. In the GONB + PRF group, patients underwent 4 min of PRF at 42℃, whereas the GONB group did not receive any PRF treatment. Follow-up examinations were performed at 1, 2, 3 and 6 months after the procedure to evaluate the frequency and severity of migraine attacks, number of headache days, and analgesic consumption.ResultsIn the GONB + PRF group, the visual analog scale (VAS) score, number of migraine attacks, number of headache days, and analgesic consumption were significantly lower compared to the GONB group (P < 0.05). Significant decreases (60%) in mean VAS scores, number of migraine attacks, number of headache days, and consumption of analgesic medications were observed in the GONB + PRF group at the 1-, 2-, 3-, and 6-month follow-ups compared with the pre-treatment period (P < 0.05).ConclusionsThe combination of GONB and PRF presents a promising new treatment option for patients with chronic migraine. This approach has demonstrated efficacy in minimizing analgesic use, decreasing the frequency of migraine attacks, reducing the number of headache days and decreasing the severity of migraine attacks.Trial RegistrationNCT05464212.