Efficacy of Greater Occipital Nerve Block in Treatment and Prevention of Chronic Migraine

Syed Zeeshan Haider; Rao Ali Shan  Khan; Muhammad Rashid  Iqbal; Irum Noor; Muhammad Huzaifa Shareef; Abid Khan

doi:10.51253/pafmj.v76i5.11111

Authors

Syed Zeeshan Haider Department of Anesthesiology, Combined Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Rao Ali Shan Khan Department of Anesthesiology, Combined Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Muhammad Rashid Iqbal Department of Anesthesiology, Combined Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Irum Noor Department of Internal medicine, Gomal Medical college, Dera Ismail Khan Pakistan
Muhammad Huzaifa Shareef Department of Anesthesiology, Combined Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Abid Khan Department of Anesthesiology, Pak Emirates Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan

DOI:

https://doi.org/10.51253/pafmj.v76i5.11111

Keywords:

Chronic Migraine, Greater Occipital Nerve Block, Pharmacological Therapy

Abstract

Objective: To assess the efficacy of greater occipital nerve (GON) block in treatment and prevention of chronic migraine.

Study Design: Quasi-experimental study.

Place and Duration of Study: Department of Anesthesia, Combined Military Hospital, Rawalpindi Pakistan, from May to Oct 2023.

Methodology: A total of 50 patients with chronic migraine fulfilling our inclusion criteria were randomly divided into two groups, i.e. Group-O (received GON block) and Group-C (managed with pharmacological therapy). Patients were followed over a period of 3 months. The grading of pain was done with the help of visual analogue score (VAS) into no pain, mild pain, moderate pain and severe pain. The frequency of different pain grades and patient satisfaction were compared with help of chi-square analysis to compute p-value.

Results: Out of 50 patients, 19(38.0%) were male while 31(62.0%) were females and mean age Group-O patients was 40.00±11.37 years and Group-C patients was 37.08±10.07 years. 17(68.0%) patients in Group-O had no pain 30 minutes after the application of greater occipital nerve block compared to 5(20.0%) patients who had no pain after multimodal analgesia while 8(32%) patients in Group-O had mild pain compared to 13(52.0%) patients in Group-C with p-value <0.001.

Conclusion: It is safe to conclude that greater occipital nerve block is a better alternative to pharmacological agents in treating and preventing chronic migraine.

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References

1. Martelleti P. Erratum to: 1st Joint ANIRCEF-SISC Congress. J Headache Pain 2017; 18(1): 11.

https://doi.org/10.1186/s10194-016-0709-7

2. AlHarbi FG, AlAteeq MA. Quality of life of migraine patients followed in neurology clinics in Riyadh, Saudi Arabia. J FamMed 2020; 27(1): 37.

https://doi.org/10.4103/jfcm.jfcm_185_19

3. Stovner LJ, Nichols E, Steiner TJ, Vos T. Headache in the Global Burden of Disease (GBD) studies. Societal Impact of Headache: Burden, Costs and Response. Springer; 2019: 105-125.

https://doi.org/10.1007/978-3-030-24728-7_9

4. Fuller-Thomson E, Hodgins GA. Suicide attempts among those with migraine: findings from a nationally representative Canadian study. Arch Suicide Res 2019; 11(4): 113-116.

https://doi.org/10.1080/13811118.2019.1578710

5. Miller S. The acute and preventative treatment of episodic migraine. Ann Indian Acad Neurol 2012; 15(Suppl 1): 33-34.

https://doi.org/10.4103/0972-2327.99998

6. Agostoni EC, Barbanti P, Calabresi P, Colombo B, Cortelli P, Frediani F. Current and emerging evidence-based treatment options in chronic migraine: a narrative review. J Headache Pain 2019; 20(3): 1-9. https://doi.org/10.1186/s10194-019-1038-4

7. Gawde P, Shah H, Patel H, Bharathi KS, Patel N, Sethi Y, et al. Revisiting Migraine: The Evolving Pathophysiology and the Expanding Management Armamentarium. Cureus 2023; 15(2): e34553. https://doi.org/10.7759/cureus.34553

8. Cuadrado ML, Aledo-Serrano Á, Navarro P, Lopez-Ruiz P, Fernández-de-Las-Peñas C, Gonzalez-Suarez I, et al. Short-term effects of greater occipital nerve blocks in chronic migraine: a double-blind, randomised, placebo-controlled clinical trial. Cephalalgia 2017; 37(9): 864-872.

https://doi.org/10.1177/0333102416655159

9. Cuadrado ML, Aledo-Serrano Á, Navarro P, Lopez-Ruiz P, Fernández-de-Las-Peñas C, Gonzalez-Suarez I, et al. Short-term effects of greater occipital nerve blocks in chronic migraine: a double-blind, randomised, placebo-controlled clinical trial. Cephalalgia 2017; 37(9): 864-872.

https://doi.org/10.1177/0333102416655159

10. Ornello R, Guerzoni S, Baraldi C, Evangelista L, Frattale I, Marini C, et al. Sustained response to onabotulinumtoxin A in patients with chronic migraine: real-life data. J Headache Pain 2020; 21(1): 40. https://doi.org/10.1186/s10194-020-01113-6

11. 11 . Matharu M, Khan U, McCulloch S, Shanahan P. POH05 Efficacy and safety of greater occipital nerve blocks in cluster headache. J Neurol Neurosurg Psychiatry 2010; 81(11): e52.

https://doi.org/10.1136/jnnp.2010.226340.139

12. Stern JI, Chiang CC, Kissoon NR, Robertson CE. Narrative review of peripheral nerve blocks for the management of headache. Headache 2022; 62(9): 1077-1092.

https://doi.org/10.1111/head.14385

13. Son BC. Entrapment of the greater occipital nerve with chronic migraine and severe facial pain: a case report. J Neurol Surg 2021; 82(05): 494-499.

https://doi.org/10.1055/s-0040-1719109

14. Schwarz A, Ziegeler C, Daneshkhah S, May A, Luedtke K. Predicting the outcome of the greater occipital nerve block–an observational study on migraine patients with and without musculoskeletal cervical impairment. Cephalalgia 2021; 41(1): 78-89.

https://doi.org/10.1177/0333102420954518

15. Castillo-Álvarez F, de la Bárcena IH, Marzo-Sola ME. Greater occipital nerve block in the treatment of headaches. Review of evidence. Med Clín 2023; 161(3): 113-118.

https://doi.org/10.1016/j.medcli.2023.04.001

16. Chowdhury D, Tomar A, Deorari V, Duggal A, Krishnan A, Koul A. Greater occipital nerve blockade for the preventive treatment of chronic migraine: A randomized double-blind placebo-controlled study. Cephalalgia 2023; 43(2): 112-119.

https://doi.org/10.1177/03331024221143541

17. Ryu JH, Shim JH, Yeom JH, Shin WJ, Cho SY, Jeon WJ. Ultrasound-guided greater occipital nerve block with botulinum toxin for patients with chronic headache in the occipital area: a randomized controlled trial. Korean J Anesthesiol 2019; 72(5): 479-485.

https://doi.org/10.4097/kja.19145

18. Arab A, Khoshbin M, Karimi E, Saberian G, Saadatnia M, Khorvash F. 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. J Neurol Sci 2022; 43(1): 549-557.

https://doi.org/10.1007/s10072-021-05295-y