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Mustafa MS, Bin Amin S, Kumar A, Shafique MA, Fatima Zaidi SM, Arsal SA, Rangwala BS, Iqbal MF, Raja A, Haseeb A, Jawed I, Hussien Mohamed Ahmed KA, Muhammad Sinaan Ali S, Varrassi G. Assessing the effectiveness of greater occipital nerve block in chronic migraine: a systematic review and meta-analysis. BMC Neurol 2024; 24:330. [PMID: 39244547 PMCID: PMC11380438 DOI: 10.1186/s12883-024-03834-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 08/28/2024] [Indexed: 09/09/2024] Open
Abstract
BACKGROUND & AIMS Chronic migraine poses a global health burden, particularly affecting young women, and has substantial societal implications. This study aimed to assess the efficacy of Greater Occipital Nerve Block (GONB) in individuals with chronic migraine, focusing on the impact of local anesthetics compared with placebo. METHODS A meta-analysis and systematic review were conducted following the PRISMA principles and Cochrane Collaboration methods. Eligible studies included case-control, cohort, and randomized control trials in adults with chronic migraine, adhering to the International Classification of Headache Disorders, third edition (ICHD3). Primary efficacy outcomes included headache frequency, duration, and intensity along with safety assessments. RESULTS Literature searches across multiple databases yielded eight studies for qualitative analysis, with five included in the final quantitative analysis. A remarkable reduction in headache intensity and frequency during the first and second months of treatment with GONB using local anesthetics compared to placebo has been reported. The incidence of adverse events did not differ significantly between the intervention and placebo groups. CONCLUSION The analysis emphasized the safety and efficacy of GONB, albeit with a cautious interpretation due to the limited number of studies and relatively small sample size. This study advocates for further research exploring various drugs, frequencies, and treatment plans to enhance the robustness and applicability of GONB for chronic migraine management.
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Affiliation(s)
- Muhamad Saqlain Mustafa
- Department of Medicine, Jinnah Sindh Medical University, Karachi, 75510, Pakistan
- Jinnah Sindh Medical University, Rafiqi H J Shaheed Road, Karachi, 75510, Pakistan
| | - Shafin Bin Amin
- Department of Medicine, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, 75400, Pakistan
- Shaheed Mohtarma Benazir Bhutto Medical College, Lyari Hospital Rd, Rangiwara Karachi, Karachi, 75400, Pakistan
| | - Aashish Kumar
- Department of Medicine, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, 75400, Pakistan
- Shaheed Mohtarma Benazir Bhutto Medical College, Lyari Hospital Rd, Rangiwara Karachi, Karachi, 75400, Pakistan
| | - Muhammad Ashir Shafique
- Department of Medicine, Jinnah Sindh Medical University, Karachi, 75510, Pakistan
- Jinnah Sindh Medical University, Rafiqi H J Shaheed Road, Karachi, 75510, Pakistan
| | - Syeda Mahrukh Fatima Zaidi
- Department of Medicine, Dow University of Health Science, Karachi, 74200, Pakistan
- Dow University of Health Sciences, Mission Rd, New Labour Colony Nanakwara, Karachi, 74200, Pakistan
| | - Syed Ali Arsal
- Department of Medicine, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, 75400, Pakistan
- Shaheed Mohtarma Benazir Bhutto Medical College, Lyari Hospital Rd, Rangiwara Karachi, Karachi, 75400, Pakistan
| | - Burhanudin Sohail Rangwala
- Department of Medicine, Jinnah Sindh Medical University, Karachi, 75510, Pakistan
- Jinnah Sindh Medical University, Rafiqi H J Shaheed Road, Karachi, 75510, Pakistan
| | - Muhammad Faheem Iqbal
- Department of Medicine, Dow University of Health Science, Karachi, 74200, Pakistan
- Dow University of Health Sciences, Mission Rd, New Labour Colony Nanakwara, Karachi, 74200, Pakistan
| | - Adarsh Raja
- Department of Medicine, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, 75400, Pakistan
- Shaheed Mohtarma Benazir Bhutto Medical College, Lyari Hospital Rd, Rangiwara Karachi, Karachi, 75400, Pakistan
| | - Abdul Haseeb
- Department of Medicine, Jinnah Sindh Medical University, Karachi, 75510, Pakistan
- Jinnah Sindh Medical University, Rafiqi H J Shaheed Road, Karachi, 75510, Pakistan
| | - Inshal Jawed
- Department of Medicine, Dow University of Health Science, Karachi, 74200, Pakistan
- Dow University of Health Sciences, Mission Rd, New Labour Colony Nanakwara, Karachi, 74200, Pakistan
| | | | - Syed Muhammad Sinaan Ali
- Department of Medicine, Liaquat National Hospital and Medical College, Karachi, Pakistan
- Liaquat National Hospital & Medical College, Stadium Road, Karachi, 74800, Pakistan
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Saglam L, Coskun O, Gunver MG, Kale A, Gayretli O. An anatomical analysis of the occipital nerve complex: an essential tool for the application of occipital nerve blocks. BMC Neurol 2024; 24:308. [PMID: 39217283 PMCID: PMC11365165 DOI: 10.1186/s12883-024-03814-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 08/20/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Occipital nerve blocks are essential in diagnosing and treating headache disorders such as migraine, cervicogenic headache, occipital neuralgia, and cluster headache. In this study, we aimed to investigate the potential compression points of the greater occipital nerve (GON), third occipital nerve (TON), and lesser occipital nerve (LON) which are targeted to block in occipital nerve blocks and to develop a method to detect these points easily. METHODS To identify potential compression points of the GON, TON, and LON, we dissected 43, 41, and 26 cadavers, respectively. A rigid, transparent tool divided into 1 × 1 cm sections was placed on the external occipital protuberance to measure the determined points. The cadaveric head was viewed from above, vertically, and the coordinates corresponding to each point were noted separately. RESULTS Six, four, and one potential entrapment points were detected for the GON, TON, and LON, respectively. The distances of the point where the GON arose from the lower border of the obliquus capitis inferior muscle and the emerging point of the TON from the C2-C3 vertebrae to the posterior midline were statistically significant in terms of the sides (p = 0.040). Similarly, there was a statistical significance between genders for the distance of the point where the LON arose from the posterior edge of the sternocleidomastoid muscle to the posterior midline (p = 0.002). CONCLUSIONS We believe that with the method developed, the GON, TON, and LON compression points can be easily localized and blocked in diagnosing and treating patients experiencing headaches such as migraines, cervicogenic headaches, occipital neuralgia, and cluster headache.
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Affiliation(s)
- Latif Saglam
- Department of Anatomy, Istanbul Faculty of Medicine, Istanbul University, Millet Caddesi, Fatih, Istanbul, 34093, Turkey.
| | - Osman Coskun
- Department of Anatomy, Istanbul Faculty of Medicine, Istanbul University, Millet Caddesi, Fatih, Istanbul, 34093, Turkey
| | - Mehmet Guven Gunver
- Department of Biostatistics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aysin Kale
- Department of Anatomy, Istanbul Faculty of Medicine, Istanbul University, Millet Caddesi, Fatih, Istanbul, 34093, Turkey
| | - Ozcan Gayretli
- Department of Anatomy, Istanbul Faculty of Medicine, Istanbul University, Millet Caddesi, Fatih, Istanbul, 34093, Turkey
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Perdecioğlu GRG, Ateş MP, Yürük D, Can E, Yıldız G, Akkaya ÖT. A new neuromodulation method in chronic migraine; non-ınvasive pulsed radiofrequency, a single-blinded, randomised, controlled trial. Ir J Med Sci 2024; 193:1487-1493. [PMID: 38147268 DOI: 10.1007/s11845-023-03598-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/19/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVE Non-invasive pulsed radiofrequency (NipRF) therapy, a neuromodulation method for peripheral nerves, is a new treatment modality for pain. We aimed to show the changes in pain severity and frequency per month in chronic migraine with NipRF treatment. METHODS We treated patients diagnosed with chronic migraine according to the International Classification of Headache Disorders III beta diagnostic criteria. In half of the patients, we applied pulsed radiofrequency (pRF) treatment with transcutaneous electrodes to the greater occipital nerve (GON) trace. In the other half, we applied the GON block under ultrasound guidance. The Migraine Disability Assessment Scale (MIDAS) was administered to the participants, and those with scores > 2 were included in the study. Pain intensity and frequency were evaluated using the visual analog scale (VAS) and a headache diary completed before and 4 weeks after treatment. RESULTS When both groups were compared, the pre- and post-treatment VAS scores and headache frequencies were similar. Comparing the pre-treatment and post-treatment values within the groups, VAS scores and headache frequency decreased significantly after treatment in both groups (p < 0.001). CONCLUSION In this study, we observed that NipRF treatment is safe and effective for treating chronic migraine. Pain intensity and frequency decreased with NipRF treatment, similar to that in the GON block group. CLINICAL TRIALS REGISTRATION NUMBER NCT05499689, Date: 08/11/2022.
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Affiliation(s)
- Gevher Rabia Genç Perdecioğlu
- Department of Algology, Etlik City Hospital Integrated Health Campus, Ankara.Varlık, Halil Sezai Erkut Avenue No:5 Yenimahalle, 06170, Ankara, Turkey.
| | - Mehlika Panpallı Ateş
- Departmant of Neurology, Etlik City Hospital Integrated Health Campus, Ankara, Turkey
| | - Damla Yürük
- Department of Algology, Etlik City Hospital Integrated Health Campus, Ankara.Varlık, Halil Sezai Erkut Avenue No:5 Yenimahalle, 06170, Ankara, Turkey
| | - Ezgi Can
- Department of Algology, Etlik City Hospital Integrated Health Campus, Ankara.Varlık, Halil Sezai Erkut Avenue No:5 Yenimahalle, 06170, Ankara, Turkey
| | - Gökhan Yıldız
- Department of Algology, Etlik City Hospital Integrated Health Campus, Ankara.Varlık, Halil Sezai Erkut Avenue No:5 Yenimahalle, 06170, Ankara, Turkey
| | - Ömer Taylan Akkaya
- Department of Algology, Etlik City Hospital Integrated Health Campus, Ankara.Varlık, Halil Sezai Erkut Avenue No:5 Yenimahalle, 06170, Ankara, Turkey
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Unal HA, Basarı A, Celiker OS, Cakar Turhan KS, Asik I, Ozgencil GE. Comparison of Greater Occipital Nerve Blockade and Sphenopalatine Ganglion Blockade in Patients with Episodic Migraine. J Clin Med 2024; 13:3027. [PMID: 38892738 PMCID: PMC11173077 DOI: 10.3390/jcm13113027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 05/12/2024] [Accepted: 05/15/2024] [Indexed: 06/21/2024] Open
Abstract
Objectives: Compare the effects of greater occipital nerve (GON) and sphenopalatine ganglion (SPG) blocks on headache intensity and duration, number of headache days, and disability in patients with episodic migraine. Methods: In this prospective single-blind randomized study, patients with episodic migraine were randomly divided into two groups: GON and SPG block groups. Patients received blocks once a week for 4 weeks, and once a month for 2 months. The number of headache days, the headache duration, numeric rating scale (NRS) scores, and number of acute medical treatments were assessed before the procedures and 1 month, 2 months, and 3 months after the procedures. Disability was evaluated using the migraine disability assessment (MIDAS) questionnaire at baseline and 3 months after treatment. This study protocol is registered at ClinicalTrials.gov (NCT06243874.). Results: 19 patients in the GON block group and 18 patients in the SPG block group were evaluated. Significant improvements in pain severity, headache duration, number of headache days, and the need for acute medical treatment were observed in the 1st, 2nd, and 3rd months compared to baseline in the two groups (p < 0.001). There were significant improvements in the MIDAS scores in the third month (p < 0.001). The GON block group showed a greater reduction in headache intensity, duration, number of headache days, and MIDAS scores compared to the SPG block group in the 3rd month (p < 0.001). Conclusions: GON block reduces headache duration, intensity, the number of headache days, and the need for acute medical treatment much more than SPG block in patients with episodic migraine.
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Affiliation(s)
- Hanzade Aybuke Unal
- Department of Anesthesiology and Reanimation, Division of Pain Medicine, Ankara University School of Medicine, Ankara 06230, Turkey; (H.A.U.); (A.B.); (I.A.); (G.E.O.)
| | - Ahmet Basarı
- Department of Anesthesiology and Reanimation, Division of Pain Medicine, Ankara University School of Medicine, Ankara 06230, Turkey; (H.A.U.); (A.B.); (I.A.); (G.E.O.)
| | - Opal Sezgi Celiker
- Department of Anesthesiology and Reanimation, Ankara University School of Medicine, Ankara 06230, Turkey;
| | - Keziban Sanem Cakar Turhan
- Department of Anesthesiology and Reanimation, Ankara University School of Medicine, Ankara 06230, Turkey;
| | - Ibrahim Asik
- Department of Anesthesiology and Reanimation, Division of Pain Medicine, Ankara University School of Medicine, Ankara 06230, Turkey; (H.A.U.); (A.B.); (I.A.); (G.E.O.)
| | - Gungor Enver Ozgencil
- Department of Anesthesiology and Reanimation, Division of Pain Medicine, Ankara University School of Medicine, Ankara 06230, Turkey; (H.A.U.); (A.B.); (I.A.); (G.E.O.)
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Vanderpol J, Kennedy G, Ahmed F, Jonker L. Efficacy of greater occipital nerve block treatment for migraine and potential impact of patient positioning during procedure: Results of randomised controlled trial. Clin Neurol Neurosurg 2024; 239:108210. [PMID: 38460427 DOI: 10.1016/j.clineuro.2024.108210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 03/11/2024]
Abstract
PURPOSE Assess the efficacy, and potential impact of patient positioning for 10 minutes immediately post-procedure, of greater occipital nerve (GON) block for treatment of migraine. METHODS Prospective multicentre non-blinded randomised controlled trial, randomisation and treatment of 60 neurology clinic patients with poorly controlled migraine. Outcomes measured with Headache Impact Test-6 (HIT-6), modified MIgraine Disability Assessment Scale (M-MIDAS), and RELIEF scores. RESULTS Patient positioning did not lead to significant difference in RELIEF score (34% vs 11%, p-value 0.10, Chi-squared test) at day 90. When considered in a multiple regression analysis, the sitting position outperformed supine position significantly (p-value 0.04). However, no significant difference in HIT-6 score between the supine (n = 27) and sitting position groups (n = 33) was detected at baseline (p-value 0.76), day 30 (p-value 0.69) or day 90 (p-value 0.54, Mann-Whitney U-test). The HIT-6 score significantly improved post-GON block, from median 67 (baseline pre-GON) to 59 (day 30) and 62 (day 90) for the supine group and a score of 66, 61-62 for the sitting group (all p-value ≤ 0.001, intra-group comparison using Wilcoxon test); M-MIDAS achieved similar outcomes. Overall, a significant minimal clinically important improvement was obtained with GON block, and the GON injections were deemed very tolerable by patients (median score of 2 on 10 cm pain scale). CONCLUSION Regardless of patient positioning, GON block is an effective and near-painless procedure for migraine symptom control. Unlike earlier published observational study data, this trial concludes that a sitting patient position immediately post-GON is preferred.
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Affiliation(s)
- Jitka Vanderpol
- North Cumbria Integrated Care NHS Foundation Trust, Penrith CA11 8HX, UK.
| | - Gina Kennedy
- South Tyneside and Sunderland NHS Foundation Trust, Sunderland SR4 7TP, UK.
| | - Fayyaz Ahmed
- Hull University Hospitals NHS Trust, Hull HU3 2JZ, UK.
| | - Leon Jonker
- North Cumbria Integrated Care NHS Foundation Trust, Carlisle CA1 3SX, UK; University of Cumbria, Carlisle CA1 2HH.
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Saglam L, Gayretli O, Coskun O, Kale A. Morphological features of the greater occipital nerve and its possible importance for interventional procedures. J Anat 2024; 244:312-324. [PMID: 37777340 PMCID: PMC10780152 DOI: 10.1111/joa.13959] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/18/2023] [Accepted: 09/18/2023] [Indexed: 10/02/2023] Open
Abstract
Being one of the most prevalent neurological symptoms, headaches are burdensome and costly. Blocks and decompression surgeries of the greater occipital nerve (GON) have been frequently used for migraine, cervicogenic headache, and occipital neuralgia which are classified under headache by International Headache Society. Knowledge of complex anatomy of GON is crucial for its decompression surgery and block. This study was performed to elucidate anatomical features of this nerve in detail. Forty-one cadavers were dissected bilaterally. According to its morphological features, GON was classified into four main types that included 18 subtypes. Moreover, potential compression points of the nerve were defined. The number of branches of the GON up to semispinalis capitis muscle and the number of its branches that were sent to this muscle were recorded. The most common variant was that the GON pierced the aponeurosis of the trapezius muscle, curved around the lower edge of the obliquus capitis inferior muscle, and was loosely attached to the obliquus capitis inferior muscle (Type 2; 61 sides, 74.4%). In the subtypes, the most common form was Type 2-A (44 sides, 53.6%), in which the GON pierced the aponeurosis of each of the trapezius muscle and fibers of semispinalis muscle at one point and there was a single crossing of the GON and occipital artery. Six potential compression points of the GON were detected. The first point was where the nerve crossed the lower border of the obliquus capitis inferior muscle. The second and third points were at its piercing of the semispinalis capitis muscle and the muscle fibers/aponeurosis of the trapezius, respectively. Fourth, fifth, and sixth compression points of GON were located where the GON and occipital artery crossed each other for the first, second, and third times, respectively. On 69 sides, 1-4 branches of the GON up to the semispinalis capitis muscle were observed (median = 1), while 1-4 branches of GON were sent to the semispinalis capitis muscle on 67 sides (median = 1). The novel anatomical findings described in this study may play a significant role in increasing the success rate of invasive interventions related with the GON.
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Affiliation(s)
- Latif Saglam
- Department of Anatomy, Istanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Ozcan Gayretli
- Department of Anatomy, Istanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Osman Coskun
- Department of Anatomy, Istanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Aysin Kale
- Department of Anatomy, Istanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
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Knoedler L, Chartier C, Casari ME, Amador RO, Odenthal J, Gfrerer L, Austen WG. Relative Pain Reduction and Duration of Nerve Block Response Predict Outcomes in Headache Surgery: A Prospective Cohort Study. Plast Reconstr Surg 2023; 152:1319-1327. [PMID: 37067978 DOI: 10.1097/prs.0000000000010552] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
BACKGROUND Experts agree that nerve block (NB) response is an important tool in headache surgery screening. However, the predictive value of NBs remains to be proven in a prospective fashion. METHODS Pre-NB and post-NB visual analogue pain scores (0 to 10) and duration of NB response were recorded prospectively. Surgical outcomes were recorded prospectively by calculating the Migraine Headache Index (MHI) preoperatively and postoperatively at 3 months, 12 months, and every year thereafter. RESULTS The study population included 115 patients. The chance of achieving MHI percentage improvement of 80% or higher was significantly higher in subjects who reported relative pain reduction of greater than 60% following NB versus less than or equal to 60% [63 of 92 (68.5%) versus 10 of 23 (43.5%); P = 0.03]. Patients were more likely to improve their MHI 50% or more with relative pain reduction of greater than 40% versus 40% or less [82 of 104 (78.8%) versus five of 11 (45.5%); P = 0.01]. In subjects with NB response of greater than 15 days, 10 of 13 patients (77.0%) experienced MHI improvement of 80% or greater. Notably, all of these patients (100%) reported MHI improvement of 50% or greater, with mean MHI improvement of 88%. Subjects with a NB response of 24 hours or more achieved significantly better outcomes than patients with a shorter response (72.7% ± 37.0% versus 46.1% ± 39.7%; P = 0.02). However, of 14 patients reporting NB response of less than 24 hours, four patients had MHI improvement of 80% or greater, and seven, of 50% or greater. CONCLUSIONS Relative pain reduction and duration of NB response are predictors of MHI improvement after headache surgery. NBs are a valuable tool to identify patients who will benefit from surgery. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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Affiliation(s)
- Leonard Knoedler
- From the Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School
| | - Christian Chartier
- From the Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School
| | - Maria E Casari
- From the Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School
| | - Ricardo O Amador
- From the Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School
| | - Jan Odenthal
- From the Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School
| | - Lisa Gfrerer
- From the Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School
- Division of Plastic and Reconstructive Surgery, Weill Cornell Medicine
| | - William G Austen
- From the Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School
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Vinyes D, Muñoz-Sellart M, Fischer L. Therapeutic Use of Low-Dose Local Anesthetics in Pain, Inflammation, and Other Clinical Conditions: A Systematic Scoping Review. J Clin Med 2023; 12:7221. [PMID: 38068272 PMCID: PMC10707454 DOI: 10.3390/jcm12237221] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/15/2023] [Accepted: 11/18/2023] [Indexed: 08/13/2024] Open
Abstract
The use of low-dose local anesthetics (LAs) has significantly transformed patient care by providing rapid and effective relief of pain and other clinical conditions while minimizing recovery time. This study aims to identify and describe the existing scientific evidence on the therapeutic use of low-dose LAs in various conditions and to identify gaps in the current literature in order to prioritize future research. This systematic scoping review adhered to the methodological guidelines outlined in the Arksey and O'Malley framework, which includes five distinct stages. Of the 129 studies included, 37.98% (n = 49) were clinical trials, 55.03% (n = 71) were observational studies, and 6.97% (n = 9) were systematic reviews. The most commonly reported indication for the use of low-dose LAs was chronic pain management (72.86%), followed by acute pain management (13.17%). Additionally, non-pain-related indications were also identified (13.95%). Overall, the administration of low-dose, short-acting LAs demonstrated favorable outcomes in terms of pain management and reduction in anxiety and depression scales, thereby having a positive impact on the patients' quality of life. This review represents the first systematic scoping review regarding the therapeutic role of LAs. To substantiate the reported positive effects on efficacy and safety, further rigorous research comprising larger, well-designed randomized controlled trials (RCTs) and long-term outcome monitoring is imperative.
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Affiliation(s)
- David Vinyes
- Institute of Neural Therapy and Regulatory Medicine, 08202 Sabadell, Spain;
- Master of Permanent Training in Medical and Dental Neural Therapy, University of Barcelona—IL3, 08018 Barcelona, Spain
- Neural Therapy Research Foundation, 08202 Sabadell, Spain
| | - Montserrat Muñoz-Sellart
- Institute of Neural Therapy and Regulatory Medicine, 08202 Sabadell, Spain;
- Master of Permanent Training in Medical and Dental Neural Therapy, University of Barcelona—IL3, 08018 Barcelona, Spain
- Neural Therapy Research Foundation, 08202 Sabadell, Spain
| | - Lorenz Fischer
- Formerly Neural Therapy, Institute of Complementary and Integrative Medicine (IKIM), University of Bern, 3012 Bern, Switzerland;
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Evcili G, Yabalak A. Evaluation of the efficacy of peripheral nerve block alone in episodic and chronic migraine patients. ARQUIVOS DE NEURO-PSIQUIATRIA 2023; 81:734-739. [PMID: 37536366 PMCID: PMC10468243 DOI: 10.1055/s-0043-1771494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 10/06/2022] [Indexed: 08/05/2023]
Abstract
BACKGROUND Peripheral nerve block (PNB) is usually performed in patients with migraine who are resistant to treatment with medications. OBJECTIVE To compare the efficacy of PNB alone and PNB combined with prophylactic medications in migraine patients. METHOD The data on migraine patients who underwent PNB in our clinic between November 2019 and January 2022 were retrospectively reviewed. Blocks of the greater occipital nerve (GON), lesser occipital nerve (LON) and supraorbital nerve (SON) were performed upon admission and in the second week. RESULTS The study included 116 patients. While 21 out of 39 episodic migraine (EM) patients continued to use prophylactic medications, 18 were followed up with PNB alone. While 49 out of 77 chronic migraine (CM) patients continued to use prophylactic medications, 28 were followed up with PNB alone. Comparison of the admission and second-month data of the patients who only underwent PNB and those who continued the drug treatment together with PNB in both the EM and the CM group showed that the number of days with pain, number of analgesics taken and scores on the Visual Analog Scale (VAS) and the Migraine Disability Assessment (MIDAS) were significantly reduced in both groups (p < 0.01). Comparison of the second-month data of the patients followed up with PNB alone and those followed up with PNB together with prophylactic medications showed that there was no significant difference between the EM and CM patients (p > 0.05). CONCLUSION Bilateral GON, LON and SON block with lidocaine injection seems to be an effective treatment on its own, without the need for prophylactic medications, in both EM and CM patients during a two-month follow-up.
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Affiliation(s)
- Gokhan Evcili
- University of Health Sciences, Derince Training and Research Hospital, Department of Neurology, Kocaeli, Turkey.
| | - Ahmet Yabalak
- Duzce University, Faculty of Medicine, Department of Neurology, Duzce, Turkey.
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Castillo-Álvarez F, Hernando de la Bárcena I, Marzo-Sola ME. Greater occipital nerve block in the treatment of headaches. Review of evidence. Med Clin (Barc) 2023:S0025-7753(23)00177-X. [PMID: 37100680 DOI: 10.1016/j.medcli.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/01/2023] [Accepted: 04/04/2023] [Indexed: 04/28/2023]
Abstract
INTRODUCTION Peripheral nerve blocks have been a common treatment for multiple headaches. By far, the greater occipital nerve block is the most used and with the stronger body of evidence in routine clinical practice. METHODS We searched Pubmed Meta-Analysis/Systematic Review, in the last 10 years. Of these results, meta-analyses, and in the absence of these systematic reviews, assessing Greater Occipital Nerve Block in headache has been selected for review. RESULTS We identified 95 studies in Pubmed, 13 that met the inclusion criteria. CONCLUSION Greater occipital block is an effective and safe technique, easy to perform and which has shown its usefulness in migraine, cluster headache, cervicogenic headache and Post-dural puncture headache. However, more studies are needed to clarify its long-term efficacy, its place in clinical treatment, the possible difference between different anaesthetics, the most convenient dosage and the role of concomitant use of corticosteroids.
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Evans AG, Joseph KS, Samouil MM, Hill DS, Ibrahim MM, Assi PE, Joseph JT, Kassis SA. Nerve blocks for occipital headaches: A systematic review and meta-analysis. J Anaesthesiol Clin Pharmacol 2023; 39:170-180. [PMID: 37564833 PMCID: PMC10410037 DOI: 10.4103/joacp.joacp_62_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/05/2021] [Indexed: 08/12/2023] Open
Abstract
Migraine surgeons have identified six "trigger sites" where cranial nerve compression may trigger a migraine. This study investigates the change in headache severity and frequency following nerve block of the occipital trigger site. This PRISMA-compliant systematic review of five databases searched from database inception through May 2020 is registered under the PROSPERO ID: CRD42020199369. Only randomized controlled trials utilizing injection treatments for headaches with pain or tenderness in the occipital scalp were included. Pain severity was scored from 0 to 10. Headache frequency was reported as days per week. Included were 12 RCTs treating 586 patients of mean ages ranging from 33.7 to 55.8 years. Meta-analyses of pain severity comparing nerve blocks to baseline showed statistically significant reductions of 2.88 points at 5 to 20 min, 3.74 points at 1 to 6 weeks, and 1.07 points at 12 to 24 weeks. Meta-analyses of pain severity of nerve blocks compared with treatment groups of neurolysis, pulsed radiofrequency, and botulinum toxin type A showed similar headache pain severity at 1 to 2 weeks, and inferior improvements compared with the treatment groups after 2 weeks. Meta-analyses of headache frequency showed statistically significant reductions at 1 to 6-week follow-ups as compared with baseline and at 1 to 6 weeks as compared with inactive control injections. The severity and frequency of occipital headaches are reduced following occipital nerve blocks. This improvement is used to predict the success of migraine surgery. Future research should investigate spinous process injections with longer follow-up.
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Affiliation(s)
- Adam G. Evans
- School of Medicine, Meharry Medical College, Nashville, TN, USA
| | | | - Marc M. Samouil
- School of Medicine, Meharry Medical College, Nashville, TN, USA
| | - Dorian S. Hill
- School of Medicine, Meharry Medical College, Nashville, TN, USA
| | | | - Patrick E. Assi
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jeremy T. Joseph
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Salam Al Kassis
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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12
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Aggarwal AK, Ottestad E, Pfaff KE, Huai-Yu Li A, Xu L, Derby R, Hecht D, Hah J, Pritzlaff S, Prabhakar N, Krane E, D’Souza G, Hoydonckx Y. Review of Ultrasound-Guided Procedures in the Management of Chronic Pain. Anesthesiol Clin 2023; 41:395-470. [DOI: 10.1016/j.anclin.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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13
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KIR HH. Greater occipital nerve block in patients with primary headache and early term results. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1169425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
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.
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.
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.
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.
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14
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Velásquez-Rimachi V, Chachaima-Mar J, Cárdenas-Baltazar EC, Loayza-Vidalon A, Morán-Mariños C, Pacheco-Barrios K, Posso M, Alva-Díaz C. Greater occipital nerve block for chronic migraine patients: A meta-analysis. Acta Neurol Scand 2022; 146:101-114. [PMID: 35726455 DOI: 10.1111/ane.13634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 04/05/2022] [Accepted: 05/01/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Greater occipital nerve block (GONB) is a minimally invasive procedure frequently used in patients with chronic migraine (CM); however, the quality of the evidence supporting its use is still unknown. Therefore, we aimed to conduct a systematic review, meta-analysis and quality assessment of GONB local anaesthetics combined or not with corticosteroids to prevent CM. METHODS We searched Medline, Scopus and Web of Science up to October 2020. We included randomized control trials (RCT) and observational studies assessing GONB without language restrictions. Two researchers selected the studies, extracted the data and evaluated the risk of bias independently. The primary outcomes measured to assess efficacy were the change from baseline in the intensity and frequency of headache in the intervention group compared to placebo at a onetime point. We performed a meta-analysis with random effect models, and we evaluated random errors with trial sequential analysis (TSA). We assessed the risk of bias (ROB) with the ROB2 tool and the certainty of the evidence with GRADE. RESULTS We identified 2864 studies in the databases and included three RCTs for quantitative synthesis. Most ROB assessments were 'high risk' or 'some concerns'. GONB reduced the intensity of headaches at the end of the first month (MD: -1.35, 95% CI: -2.12 to -0.59) and the second month (MD: -2.10, CI 95%: -2.94 to -1.26) as well as the frequency of headaches (first month: MD: -4.45 days, 95% CI: -6.56 to -2.34 days; second month: MD: -5.49, 95% CI -8.94 to -2.03 days). Corticosteroids did not show a significant decrease in the frequency of headaches during the first month of treatment (MD: -1.1 days, 95% CI: -4.1 to 1.8, p = .45). Included trials reported similar adverse events between groups. The exploratory TSA showed inconclusive results. Overall, the quality of the evidence was very low because of the substantial risk of bias and imprecision. CONCLUSION The limited evidence available shows that GONB with local anaesthetics could reduce headache frequency and intensity compared to placebo, while adding corticosteroids did not show additional benefits. GONB was safe with a similar number of minor adverse events. However, our confidence in these estimates is very low since the evidence is based on a few trials, with a small sample size and a significant risk of bias. In addition, the exploratory TSA was inconclusive, so we need larger and specific trials.
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Affiliation(s)
- Victor Velásquez-Rimachi
- Red de Eficacia Clínica y Sanitaria, Lima, Peru.,Grupo de Investigación en Neurociencia, Efectividad Clínica y Salud Pública, Universidad Científica del Sur, Lima, Peru.,Servicio de Neurología, Departamento de Medicina y Oficina de Apoyo a la Docencia e Investigación (OADI), Hospital Daniel Alcides Carrión, Callao, Peru
| | - Jorge Chachaima-Mar
- Red de Eficacia Clínica y Sanitaria, Lima, Peru.,Servicio de Neurología, Departamento de Medicina y Oficina de Apoyo a la Docencia e Investigación (OADI), Hospital Daniel Alcides Carrión, Callao, Peru.,Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | | | - Cristian Morán-Mariños
- Red de Eficacia Clínica y Sanitaria, Lima, Peru.,Servicio de Neurología, Departamento de Medicina y Oficina de Apoyo a la Docencia e Investigación (OADI), Hospital Daniel Alcides Carrión, Callao, Peru.,Unidad de Investigación en Bibliometría, Universidad San Ignacio de Loyola, Lima, Peru
| | - Kevin Pacheco-Barrios
- Unidad de Investigación Para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru.,Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Margarita Posso
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Carlos Alva-Díaz
- Grupo de Investigación en Neurociencia, Efectividad Clínica y Salud Pública, Universidad Científica del Sur, Lima, Peru.,Servicio de Neurología, Departamento de Medicina y Oficina de Apoyo a la Docencia e Investigación (OADI), Hospital Daniel Alcides Carrión, Callao, Peru.,Universidad Científica del Sur, Facultad de Ciencias de la Salud, Lima, Peru
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15
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Love SM, Hopkins BD, Migdal CW, Schuster NM. Occipital headache evaluation and rates of migraine assessment, diagnosis, and treatment in patients receiving greater occipital nerve blocks in an academic pain clinic. PAIN MEDICINE 2022; 23:1851-1857. [PMID: 35595240 DOI: 10.1093/pm/pnac080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 05/13/2022] [Accepted: 05/15/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Diagnosis of patients with occipital headache can be challenging, as both primary and secondary causes must be considered. Our study assessed how often migraine is screened for, diagnosed, and treated in patients receiving greater occipital nerve blocks (GONBs) in a pain clinic. DESIGN IRB-approved, retrospective observational study. SETTING Academic multidisciplinary pain clinic. SUBJECTS 143 consecutive patients who received GONBs. RESULTS About 75% of patients had been evaluated by neurologists and about 25% by non-neurologist pain specialists only. 62.2% of patients had photophobia, phonophobia, and nausea assessed. Patients who had been evaluated by a neurologist were more likely to have photophobia, phonophobia, and nausea assessed (75.9% vs 20.0%, OR 12.6, 95% CI 4.90-32.2), more likely to be diagnosed with migraine (48.1% vs 14.3%, OR 5.6, 95% CI 2.0-15), less likely to be diagnosed with occipital neuralgia (39.8% vs 65.7%, OR 0.3, 95% CI 0.2-0.8), and equally likely to be diagnosed with cervicogenic headache (21.3% vs 25.7%, OR 0.8, 95% CI 0.3-1.9) than those evaluated by non-neurologists. Among patients diagnosed with migraine, 82.5% received acute migraine treatment, 89.5% received preventive migraine treatment, and 52.6% were documented as receiving migraine lifestyle counseling. CONCLUSIONS 62.2% of patients with occipital headache receiving GONBs were assessed for migraine, and most received appropriate acute, preventive, and lifestyle treatments when diagnosed. Patients seen by neurologists were significantly more likely to be screened for, and diagnosed with, migraine than those evaluated by non-neurologist pain medicine specialists only. All clinicians should remain vigilant for migraine in patients with occipital headache.
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Affiliation(s)
- Shawn M Love
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA
| | | | | | - Nathaniel M Schuster
- Center for Pain Medicine, Department of Anesthesiology, University of California, San Diego, San Diego, CA
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16
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Impact of Greater Occipital Nerve Block on Photophobia Levels in Migraine Patients. J Neuroophthalmol 2022; 42:378-383. [PMID: 35421036 DOI: 10.1097/wno.0000000000001541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND To study the effect of greater occipital nerve (GON) block on migraine-associated photophobia levels. Photophobia is one of the most bothersome symptoms reported by migraine patients. Studies investigating the impact of migraine treatment on this symptom are scarce. METHODS This is an observational prospective case-control study. Patients with migraine and photophobia attending a Headache Clinic were recruited. Cases were defined as patients in whom GON block was performed, following usual clinical practice guidelines. All patients were evaluated with the Hospital Anxiety and Depression Scale, the Migraine Specific Quality of Life Questionnaire, the Utah Photophobia Symptom Impact Scale (UPSIS-12), and the Korean Photophobia Questionnaire (KUMC-8); both in the first visit (V1) and one week after (V2). RESULTS Forty-one patients were recruited, 28 (68.3%) cases and 13 (31.7%) controls. At V1, there were no significant differences in the median [p25-p75] score of UPSIS-12 in cases vs controls (32.0 [21.0-34.0] vs 30.5 [22.0-37.0], P = 0.497) or KUMC-8 (6.5 [5.5-7.0] vs 7.0 [6.0-8.0], P = 0.463). At V2, cases experimented a significant improvement in UPSIS-12 of -5.5 [-8.8 to -1.3] and in KUMC-8 of -0.5 [-2.0 to 0], whereas there were no significant changes in the control group. Migraine with aura patients presented higher UPSIS-12 score at V1 (33.5 [24.5-37.0] vs 26.0 [16.0-35.0]) and lesser improvement at V2 after GON block compared with migraine without aura patients (-4.0 [-6.0 to -1.0] vs -8.0 [-17.0 to -2.0]), although statistical significance was not achieved (P = 0.643 and P = 0.122, respectively). There was no significant variation in the remaining scales. CONCLUSIONS Greater occipital nerve block improves migraine-associated photophobia, measured with UPSIS-12 and KUMC-8. Patients without aura may exhibit a greater improvement. Physicians could consider GON block for management of photophobia in migraine patients.
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17
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Abbas A, Moustafa R, Shalash A, Haroun M, Amin R, Borham S, Elsadek A, Helmy S. Serum CGRP Changes following Ultrasound-Guided Bilateral Greater-Occipital-Nerve Block. Neurol Int 2022; 14:199-206. [PMID: 35225886 PMCID: PMC8883968 DOI: 10.3390/neurolint14010016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 01/26/2022] [Accepted: 01/30/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Calcitonin-gene-related peptide (CGRP) and CGRP receptors are expressed in trigeminal nerve cells, and treatments targeting CGRP are effective in migraines. For headaches that do not respond to pharmacological treatment, minimally invasive techniques such as greater-occipital-nerve block (GONB) can help relieve the pain and reduce the frequency of headaches. Our study assessed the efficacy of ultrasound-guided greater-occipital-nerve block (USgGONB) in chronic migraines (CM) and its relationship to serum CGRP levels. Methods: Forty chronic migraineurs who underwent bilateral USgGONB using 40 mg triamcinolone and 1 mL lidocaine were recruited and interictal serum CGRP samples were collected immediately before and one month after GONB. The clinical response was evaluated using headache diaries before and one month after USgGONB. The patient response was determined after USgGONB according to the reduction in headache days as a good responder (>50% reduction), poor responder (<50%) or non-responder. Results: Monthly headache days after GONB showed a significant reduction (median, 10 days; range, 8−14.7) compared to before the block (median, 18 days; range, 17−22; p < 0.001). Across all patients, interictal serum CGRP levels after USgGONB were significantly lower than before the block (median, 40 pg/mL (range, 25−60) vs. 145 pg/mL (range, 60−380) (p = 0.001). The pre-treatment interictal CGRP levels showed a significant difference (p = 0.003), as their levels in non-responders (median, 310 pg/mL; interquartile range, 262−350) were significantly higher than those seen in responders, whether poor responders (median, 135 pg/mL; interquartile range, 100−200 pg/mL) or good responders (median, 140 pg/mL; interquartile range, 80−150 pg/mL). Conclusion: the study showed the beneficial effect of USgGONB in chronic migraines that was associated with lowering interictal CGRP levels, implying a potential role for CGRP in the mechanism of action of GONB in CM, and the interictal CGRP level may be used as a predictor for the response to GONB.
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18
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Sico JJ, Macedo F, Lewis J, Spevak C, Vogsland R, Ford A, Skop K, Sall J. The Primary Care Management of Headache: Synopsis of the 2020 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline. Mil Med 2022; 187:e1091-e1102. [PMID: 35022782 DOI: 10.1093/milmed/usab490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/20/2021] [Accepted: 01/09/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION In June of 2020, the U.S. DVA and DoD approved a new joint clinical practice guideline for assessing and managing patients with headache. This guideline provides a framework to evaluate, treat, and longitudinally manage the individual needs and preferences of patients with headache. METHODS In October of 2018, the DVA/DoD Evidence-Based Practice Work Group convened a guideline development panel that included clinical stakeholders and conformed to the National Academy of Medicine's tenets for trustworthy clinical practice guidelines. RESULTS The guideline panel developed key questions, systematically searched and evaluated the literature, created a 1-page algorithm, and advanced 42 recommendations using the Grading of Recommendations Assessment, Development, and Evaluation system. CONCLUSION This synopsis summarizes the key features of the guideline in three areas: prevention, assessing and treating medication overuse headache, and nonpharmacologic and pharmacologic management of headache.
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Affiliation(s)
- Jason J Sico
- Headache Centers of Excellence (HCoE) Program, National Programs Center, Orange, CT 06477, USA.,HCoE Research and Evaluation Center, Veterans Health Administration.,Department of Neurology (Headache Medicine and Vascular Neurology) and Internal Medicine (General Medicine), Yale School of Medicine, New Haven, CT 06520, USA.,VA Connecticut Healthcare System Department of Neurology, National Programs Center, Orange, CT 06477, USA
| | - Franz Macedo
- Minneapolis VA Health Care System, Minneapolis, MN 55417, USA
| | - Jeffrey Lewis
- Wright-Patterson Air Force Base Mental Health Clinic, Wright-Patterson AFB, OH 45433, USA
| | - Christopher Spevak
- Physical Medicine and Rehabilitation Service, James A. Haley Veterans' Hospital, Tampa, FL 33612, USA.,Minneapolis VA Health Care System, Minneapolis, MN 55417, USA
| | | | - Aven Ford
- USAFSAM/FECN, Wright-Patterson AFB, OH 45433, USA
| | - Karen Skop
- Physical Medicine and Rehabilitation Service, James A. Haley Veterans' Hospital, Tampa, FL 33612, USA
| | - James Sall
- Quality and Patient Safety, Office of Evidence Based Practice, U.S. Department of Veterans Affairs, New Braunfels, TX 78132, USA.,Department of Clinical Anesthesia, Georgetown University School of Medicine.,Program Director Pain Fellowship, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
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19
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Friedman BW. Peripheral Nerve Blocks for Headache: A Precise Approach to Pain Management in the Emergency Department. Ann Emerg Med 2021; 79:262-264. [PMID: 34952731 DOI: 10.1016/j.annemergmed.2021.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Indexed: 11/01/2022]
Affiliation(s)
- Benjamin W Friedman
- Department of Emergency Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.
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20
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Effects of cranial nerve blockage in patients with chronic migraine resistant to first-line treatment. JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.1000962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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21
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Patel D, Yadav K, Taljaard M, Shorr R, Perry JJ. Effectiveness of Peripheral Nerve Blocks for the Treatment of Primary Headache Disorders: A Systematic Review and Meta-Analysis. Ann Emerg Med 2021; 79:251-261. [PMID: 34756448 DOI: 10.1016/j.annemergmed.2021.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/06/2021] [Accepted: 08/10/2021] [Indexed: 12/18/2022]
Abstract
STUDY OBJECTIVE Primary headache disorders are prevalent and account for 2% of all emergency department visits. Current treatment options are effective; however, time to pain relief is suboptimal. Alternatives such as peripheral nerve blocks have shown promising results. The objective of this systematic review is to examine the effectiveness of peripheral nerve blocks for timely pain relief. METHODS We searched Ovid MEDLINE, EMBASE, Web of Science Core Collection, and the Cochrane Central Register of Controlled Trials and included randomized controlled trials comparing peripheral nerve blocks to placebo or active therapy. The primary outcome was pain within 120 minutes. Secondary outcomes were pain after 120 minutes, adverse events, need for rescue medications, and relapse of headache. Two reviewers screened and extracted data independently; mean differences (MDs) were calculated, and results were pooled using a random-effects model. RESULTS Eleven studies met our eligibility criteria (n=860), of which 9 were included in the meta-analysis. Pain scores were significantly lower in patients treated with peripheral nerve blocks than with placebo at 15 minutes (MD: -1.17; 95% confidence interval: -1.82 to -0.51) and 30 minutes (MD: -0.99; 95% confidence interval: -1.66 to -0.32), and no serious adverse events were reported. Pain scores for peripheral nerve blocks versus active therapy and secondary outcomes were not pooled due to clinical heterogeneity. CONCLUSION Our review shows peripheral nerve blocks are effective as a rapid treatment option when compared to placebo; however, we were unable to assess effectiveness against standard treatment. Emergency physicians should consider peripheral nerve blocks as an adjunct therapy for patients with primary headache disorders.
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Affiliation(s)
- Dilan Patel
- School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
| | - Krishan Yadav
- Department of Emergency Medicine, University of Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Monica Taljaard
- School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Risa Shorr
- Learning Services, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Jeffrey J Perry
- School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada; Department of Emergency Medicine, University of Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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22
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İnan LE, İnan N. Greater occipital nerve block in migraine may have a place in migraine treatment. Cephalalgia 2021; 42:426. [PMID: 34553638 DOI: 10.1177/03331024211045644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Levent Ertuğrul İnan
- Health Sciences University, Ankara SUAM, Neurology and Algology Department, Ankara, Turkey
| | - Nurten İnan
- Gazi University, Faculty of Medicine, Anesthesiology and Algology Department, Ankara, Turkey
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23
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Kiarashi J, Jion Y, Giglio B, Pavlovic J, Armand CE, Grosberg BM, Lipton RB, Vollbracht S, Robbins MS. Elective Hospitalizations for Intractable Headache: Outcomes and Response Predictors. Neurol Clin Pract 2021; 11:188-193. [PMID: 34484886 DOI: 10.1212/cpj.0000000000000965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 08/19/2020] [Indexed: 11/15/2022]
Abstract
Objective To review our inpatient experience treating a variety of headache disorders with heterogeneous therapies and to determine outcomes and predictors of response. Methods We conducted an institutional review board-approved retrospective chart review of elective inpatient headache admissions from the Montefiore Headache Center from 2014 to 2018. We examined factors associated with response and outcomes at discharge and posthospitalization follow-up in an intractable population. Patients received different classes of IV medications including antiemetics, neuroleptics, dihydroergotamine, lidocaine, steroids, valproic acid, and nerve blocks, and home preventive medications were either continued or changed before discharge. Improvements were defined at discharge by headache intensity compared with before hospitalization. Results Among the 83 admissions, pain improvement at discharge occurred in 90.4% (n = 75) of the overall sample, 89.5% (n = 60) of those with chronic migraine, 75.0% (n = 9) of patients with new daily persistent headache, and 89.5% (n = 34) of all those with acute medication overuse. Fifty-six patients (67.5%) reported improvement of a 3-or-more-point reduction in headache intensity at discharge, with a mean reduction of 4.84 ± SD 2.51 (range 1-10). Of the 66 patients who received IV dihydroergotamine, 59 (89.4%) of them improved at discharge. Of the 11 (13.2%) patients who received IV lidocaine, 7 (63.6%) improved. Of the 14 (16.9%) patients who received nerve blocks, all 14 (100%) improved at discharge. Of the 75 patients who had improved at discharge, 63 (84%) followed up and 50 (79.4%) of those patients remained improved. At the second follow-up, 68 (81.9%) patients returned for follow-up on average of 71 days (range 10-283) after discharge. Conclusions Our inpatient headache experience featured numerous treatments with high rates of improvement in the short and intermediate term for all headache disorders. These results may suggest that stratified hospitalized care including polytherapy may be useful for many patients.
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Affiliation(s)
- Jessica Kiarashi
- UT Southwestern Medical Center (JK), Dallas; National Neuroscience Institute (YJ), Singapore; NYU Langone Medical Center (BG); Montefiore Medical Center (JP, CEA, RBL), Bronx, NY; Hartford Healthcare Headache Center (BMG), West Hartford, CT; Columbia University Medical Center (SV), Westchester; and Weill Cornell Medicine (MSR), New York, NY
| | - Yasmin Jion
- UT Southwestern Medical Center (JK), Dallas; National Neuroscience Institute (YJ), Singapore; NYU Langone Medical Center (BG); Montefiore Medical Center (JP, CEA, RBL), Bronx, NY; Hartford Healthcare Headache Center (BMG), West Hartford, CT; Columbia University Medical Center (SV), Westchester; and Weill Cornell Medicine (MSR), New York, NY
| | - Brandon Giglio
- UT Southwestern Medical Center (JK), Dallas; National Neuroscience Institute (YJ), Singapore; NYU Langone Medical Center (BG); Montefiore Medical Center (JP, CEA, RBL), Bronx, NY; Hartford Healthcare Headache Center (BMG), West Hartford, CT; Columbia University Medical Center (SV), Westchester; and Weill Cornell Medicine (MSR), New York, NY
| | - Jelena Pavlovic
- UT Southwestern Medical Center (JK), Dallas; National Neuroscience Institute (YJ), Singapore; NYU Langone Medical Center (BG); Montefiore Medical Center (JP, CEA, RBL), Bronx, NY; Hartford Healthcare Headache Center (BMG), West Hartford, CT; Columbia University Medical Center (SV), Westchester; and Weill Cornell Medicine (MSR), New York, NY
| | - Cynthia E Armand
- UT Southwestern Medical Center (JK), Dallas; National Neuroscience Institute (YJ), Singapore; NYU Langone Medical Center (BG); Montefiore Medical Center (JP, CEA, RBL), Bronx, NY; Hartford Healthcare Headache Center (BMG), West Hartford, CT; Columbia University Medical Center (SV), Westchester; and Weill Cornell Medicine (MSR), New York, NY
| | - Brian M Grosberg
- UT Southwestern Medical Center (JK), Dallas; National Neuroscience Institute (YJ), Singapore; NYU Langone Medical Center (BG); Montefiore Medical Center (JP, CEA, RBL), Bronx, NY; Hartford Healthcare Headache Center (BMG), West Hartford, CT; Columbia University Medical Center (SV), Westchester; and Weill Cornell Medicine (MSR), New York, NY
| | - Richard B Lipton
- UT Southwestern Medical Center (JK), Dallas; National Neuroscience Institute (YJ), Singapore; NYU Langone Medical Center (BG); Montefiore Medical Center (JP, CEA, RBL), Bronx, NY; Hartford Healthcare Headache Center (BMG), West Hartford, CT; Columbia University Medical Center (SV), Westchester; and Weill Cornell Medicine (MSR), New York, NY
| | - Sarah Vollbracht
- UT Southwestern Medical Center (JK), Dallas; National Neuroscience Institute (YJ), Singapore; NYU Langone Medical Center (BG); Montefiore Medical Center (JP, CEA, RBL), Bronx, NY; Hartford Healthcare Headache Center (BMG), West Hartford, CT; Columbia University Medical Center (SV), Westchester; and Weill Cornell Medicine (MSR), New York, NY
| | - Matthew S Robbins
- UT Southwestern Medical Center (JK), Dallas; National Neuroscience Institute (YJ), Singapore; NYU Langone Medical Center (BG); Montefiore Medical Center (JP, CEA, RBL), Bronx, NY; Hartford Healthcare Headache Center (BMG), West Hartford, CT; Columbia University Medical Center (SV), Westchester; and Weill Cornell Medicine (MSR), New York, NY
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Barad M, Ailani J, Hakim SM, Kissoon NR, Schuster NM. Percutaneous Interventional Strategies for Migraine Prevention: A Systematic Review and Practice Guideline. PAIN MEDICINE 2021; 23:164-188. [PMID: 34382092 DOI: 10.1093/pm/pnab236] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To systematically evaluate the efficacy and effectiveness of percutaneous interventional treatments for prevention of migraine through a qualitative and (when possible) quantitative analysis. METHODS 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 using 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. RESULTS The committee screened 1195 studies and assessed 352 by full text, yielding 16 randomized controlled trials that met inclusion criteria. RECOMMENDATIONS/CONCLUSIONS 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 chronic migraine prevention and a weak recommendation against use for episodic migraine prevention. Greater occipital nerve blocks received a weak recommendation for chronic migraine prevention. For greater occipital nerve block, steroid received a weak recommendation against use vs local anesthetic alone. Occipital nerve with supraorbital nerve blocks, sphenopalatine ganglion blocks, cervical spine percutaneous interventions, and implantable stimulation all received weak recommendations for chronic migraine prevention. The committee found insufficient evidence to assess trigger point injections in migraine prevention and highly discouraged use of intrathecal medication.
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Affiliation(s)
- Meredith Barad
- Anesthesia (Pain Management) and Neurology and Neurological Sciences, Stanford Hospital and Clinics, Stanford, California, USA
| | - Jessica Ailani
- Neurology, Medstar Georgetown University, Washington, DC, USA
| | - Sameh M Hakim
- Anesthesiology, Intensive Care, and Pain Management, Ain Shams University Faculty of Medicine, Cairo, Egypt
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Hokenek NM, Ozer D, Yılmaz E, Baskaya N, Hokenek UD, Ak R, Guven R, Erdogan MO, Mepham LA. Comparison of greater occipital nerve and supra orbital nerve blocks methods in the treatment of acute migraine attack: A randomized double-blind controlled trial. Clin Neurol Neurosurg 2021; 207:106821. [PMID: 34304069 DOI: 10.1016/j.clineuro.2021.106821] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/07/2021] [Accepted: 07/08/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The 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. METHODS This 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 RESULTS: In 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 CONCLUSIONS: SON 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.
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Affiliation(s)
- Nihat M Hokenek
- Department of Emergency Medicine, University of Health Sciences, Kartal Dr. Lütfi Kırdar City Hospital, İstanbul, Turkey.
| | - Duygu Ozer
- Department of Neurology, University of Health Sciences, Kartal Dr. Lütfi Kırdar City Hospital, İstanbul, Turkey
| | - Erdal Yılmaz
- Department of Emergency Medicine, University of Health Sciences, Kartal Dr. Lütfi Kırdar City Hospital, İstanbul, Turkey
| | - Nurhayat Baskaya
- Department of Emergency Medicine, University of Health Sciences, Kartal Dr. Lütfi Kırdar City Hospital, İstanbul, Turkey
| | - Ummahan Dalkilinc Hokenek
- Department of Anesthesiology and Reanimation, University of Health Sciences, Kartal Dr. Lütfi Kırdar City Hospital, İstanbul, Turkey
| | - Rohat Ak
- Department of Emergency Medicine, University of Health Sciences, Kartal Dr. Lütfi Kırdar City Hospital, İstanbul, Turkey
| | - Ramazan Guven
- Department of Emergency Medicine, Basaksehir Cam ve Sakura Hospital, İstanbul, Turkey
| | - Mehmet O Erdogan
- Department of Emergency Medicine, University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
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Chowdhury D, Datta D, Mundra A. Role of Greater Occipital Nerve Block in Headache Disorders: A Narrative Review. Neurol India 2021; 69:S228-S256. [PMID: 34003170 DOI: 10.4103/0028-3886.315993] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background The proximity of sensory neurons in the upper cervical spinal cord to the trigeminal nucleus caudalis (TNC) neurons and the convergence of sensory input to TNC neurons from both cervical and trigeminal fibers underscore the rationale of using greater occipital nerve block (GON-block) for acute and preventive treatment in various headache disorders. Objective The aim of this study was to critically review the existing literature regarding the safety and efficacy of GON-block in various headache disorders. Methods We searched the eligible studies in English by searching in PubMed till December 31, 2020 for randomized controlled trials (RCTs), observational studies, open-label studies, case series, and case reports on the efficacy and the safety of GON-block for the treatment of headache disorders using the keywords "greater occipital nerve block", "headache" and "treatment". Studies using combination of GON-block and other peripheral nerve blocks (PNBs) and C2/C3 blocks were excluded. Results Seventy-two eligible studies were reviewed. Based on RCTs and open-label studies, good evidence of the efficacy of GON-block was found for migraine, cluster headache (CH), post-dural puncture headache (PDPH), cervicogenic headache (CGH), and occipital neuralgia (ON). The analgesic effect of GON-block outlasted its anesthetic effect by days to weeks. Evidence for acute and short-term (transitional) treatment was more robust than for long-term prevention. GON-block was found to be safe and the treatment-emergent adverse effects (TEAEs) were generally mild and transient. Conclusion GON-block is a useful modality of treatment in various headache disorders because of many attractive features such as its early effect in reducing the severity of pain, sustained effect following a single injection, easy technique, minimum invasiveness, minimum TEAE, no drug-to-drug interactions, and negligible cost.
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Affiliation(s)
- Debashish Chowdhury
- Department of Neurology, GB Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - Debabrata Datta
- Department of Neurology, GB Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - Ankit Mundra
- Department of Neurology, GB Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
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Effectiveness of greater occipital nerve blocks in chronic migraine. JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.911665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Migdal CW, Moskatel LS, Schuster NM. Headache Made SIMPAL: A Simple Mnemonic for the Approach to Headache Evaluation and Migraine Treatment. PAIN MEDICINE 2021; 22:754-758. [PMID: 33735383 DOI: 10.1093/pm/pnaa429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
| | - Leon S Moskatel
- Department of Neurology, Stanford Health Care, Palo Alto, California, USA
| | - Nathaniel M Schuster
- Department of Anesthesiology, Center for Pain Medicine, UC San Diego Health System, La Jolla, California, USA
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Peripheral Occipital Nerve Decompression Surgery in Migraine Headache. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3019. [PMID: 33173659 PMCID: PMC7647655 DOI: 10.1097/gox.0000000000003019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 06/08/2020] [Indexed: 01/20/2023]
Abstract
Migraine headache in the occipital region is characterized by a recurrent pain of moderate to severe intensity. However, the diagnosis can be difficult because of the multitude of symptoms overlapping with similar disorders and a pathophysiology that is not well-understood. For this reason, the medical management is often complex and ineffective.
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Chiou JY, Abd-Elrehim T, Lin CC, Chen GS. Feasibility study of greater occipital nerve blocks by focused ultrasound - an animal study. J Neural Eng 2020; 17:056030. [PMID: 33146147 DOI: 10.1088/1741-2552/abb14d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Greater occipital nerve (GON) block may provide substantial relief for headache in the occipital location. This study tested the feasibility of focused ultrasound (FUS) to induce the conduction block of GONs in rats. APPROACH For in vitro experiments, the nerve was dissected and cut from C2 to the site near the ear of the rats and preserved in Ringer's solution. Pulsed FUS was used for the block, and sensory action potentials were recorded in the GON. For in vivo experiments, the GONs of the rats were surgically exposed for precise ultrasonic treatment. All data are expressed as the mean ± the standard deviation. MAIN RESULTS A single ultrasonic treatment temporarily suppressed the amplitude of action potentials of the in vitro nerves to 42 ± 14% of the baseline values, and the time to recovery was 55 min. The in vivo results showed that FUS acutely inhibited the amplitude of action potentials to 41 ± 8% of the baseline value in rat GONs, and the time to recovery was 67 min. Histological examination revealed no appreciable changes in the nerve morphology caused by FUS. Therefore, FUS reversibly blocked the conduction of the rat GON when the sonication parameters were appropriate. SIGNIFICANCE Noninvasive FUS may be a novel treatment paradigm for occipital headache by blocking the occipital nerve, and the procedure is repeatable if indicated.
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Affiliation(s)
- Jiun-Yi Chiou
- Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, Zhunan, Taiwan
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Chowdhury D, Mundra A. Role of greater occipital nerve block for preventive treatment of chronic migraine: A critical review. CEPHALALGIA REPORTS 2020. [DOI: 10.1177/2515816320964401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective:The aim of this study is to critically analyze the evidence of the efficacy and safety of greater occipital nerve (GON) block for the preventive treatment of chronic migraine (CM).Background:A rigorous scientific assessment of efficacy and safety of the GON block for preventive treatment in CM is not available. This critical review was undertaken for this purpose.Methods:References for this review were identified by searches of articles published in the English language in PubMed between 1969 and April 15, 2020 using “greater occipital nerve block,” “chronic migraine,” “migraine,” “headache,” and “treatment” as keywords.Results:Out of potential 532 articles, 9 open-label and 4 placebo-controlled trials that studied the role of GON block for prevention of CM were identified and reviewed. Open-label trials reported a reduction of headache severity and frequency in 35–68% of patients. The beneficial effect of a single block lasted up to 4 weeks. Randomized controlled trials (RCTs) used varied methodology and techniques of GON block and the outcomes were reported at different time points. A single RCT showed a beneficial effect of the GON block at 1 week. However, the GON block was found to be safe and well tolerated.Conclusion:Long-term efficacy of GON block in CM shall need further well-designed RCTs using standardized methodology. This study, in addition, reviewed the limitations and uncertainties regarding the technique and methods of use of GON block in CM.
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Affiliation(s)
- Debashish Chowdhury
- Department of Neurology, GB Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - Ankit Mundra
- Department of Neurology, GB Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
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Fernandes L, Randall M, Idrovo L. Peripheral nerve blocks for headache disorders. Pract Neurol 2020:practneurol-2020-002612. [PMID: 33097609 DOI: 10.1136/practneurol-2020-002612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2020] [Indexed: 02/04/2023]
Abstract
Headache is a common neurological referral and a frequent cause for acute hospital admissions. Despite peripheral nerve blocks being widely used in headache and pain services to treat patients with headache disorders, there is no readily accessible resource with instructions for the delivery of peripheral nerve blocks. Here we provide a practical approach for administering peripheral nerve blocks and cover the current evidence base for such procedures in different headache disorders. We provide instructions and an audiovisual guide for administering greater and lesser occipital, supratrochlear, supraorbital and auriculotemporal nerves blocks, and give information on their adverse effects and potential complications. This information will provide a reference for headache practitioners when giving peripheral nerve blocks safely to people with headache.
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Affiliation(s)
| | - Marc Randall
- Neurology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Headache Service, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Luis Idrovo
- Neurology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Headache Service, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Friedman BW, Irizarry E, Williams A, Solorzano C, Zias E, Robbins MS, Harrilal MA, Del Valle M, Bijur PE, Gallagher EJ. A Randomized, Double-Dummy, Emergency Department-Based Study of Greater Occipital Nerve Block With Bupivacaine vs Intravenous Metoclopramide for Treatment of Migraine. Headache 2020; 60:2380-2388. [PMID: 32981043 DOI: 10.1111/head.13961] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/16/2020] [Accepted: 08/06/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Greater occipital nerve blocks (GONB) are used increasingly to treat acute migraine. OBJECTIVE We conducted a randomized controlled trial to determine whether GONB was as effective as intravenous metoclopramide for migraine. METHODS This was a double-dummy, double-blind, parallel-arm, non-inferiority study conducted in 2 emergency departments (EDs). Patients with migraine of moderate or severe intensity were randomized to receive bilateral GONB with each side administered 3 mL of bupivacaine 0.5% or metoclopramide 10 mg IV, the putative standard of care. The primary outcome was improvement in pain on a 0-10 scale between time 0 and 1 hour later. To reject the null hypothesis that metoclopramide would be more efficacious in relieving pain, we required that the lower limit of the 95% CI for the difference in pain improvement between those randomized to GONB vs those randomized to metoclopramide be >-1.3, a validated minimum clinically important difference. Secondary outcomes included sustained headache relief, defined as achieving and maintaining for 48 hours a headache level of mild or none without the use of additional analgesic medication, and the use of rescue medication in the ED. RESULTS Over a 2.5-year study period, 1358 patients were screened for participation and 99 were randomized, 51 to GONB and 48 to metoclopramide. All of these patients were included in the primary analysis. Patients who received the GONB reported mean improvement of 5.0 (95% CI: 4.1, 5.8) while those who received metoclopramide reported a larger mean improvement of 6.1 (95% CI: 5.2, 6.9). The 95% CI for the between group difference of -1.1 was -2.3, 0.1. Sustained headache relief was reported by 11/51 (22%) GONB and 18/47 (38%) metoclopramide patients (95% CI for rounded difference of 17%: -1, 35%). Of the 51 GONB patients, 17 (33%) required rescue medication in the ED vs 8/48 (17%) metoclopramide patients (95% CI for rounded difference of 17%: 0, 33%). An adverse event was reported by 16/51 (31%) GONB patients and 18/48 (38%) metoclopramide patients (95% CI for (rounded) difference of 6%: -13, 25%). CONCLUSION GONB with bupivacaine was not as efficacious as IV metoclopramide for the first-line treatment of migraine in the ED.
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Affiliation(s)
- Benjamin W Friedman
- Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore, Bronx, NY, USA
| | - Eddie Irizarry
- Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore, Bronx, NY, USA
| | - Andrew Williams
- Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore, Bronx, NY, USA
| | | | | | - Matthew S Robbins
- Department of Neurology, Weill Cornell Medicine, New York-Presbyterian, New York, NY, USA
| | - Melissa A Harrilal
- Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore, Bronx, NY, USA
| | - Michael Del Valle
- Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore, Bronx, NY, USA
| | - Polly E Bijur
- Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore, Bronx, NY, USA
| | - E John Gallagher
- Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore, Bronx, NY, USA.,Department of Neurology, Albert Einstein College of Medicine, Montefiore, Bronx, NY, USA
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Deng Y, Chen Y, Peng Z, Yang H. The Efficacy and Safety of DFN-15 for the Treatment of Migraine: A Meta-Analysis of Randomized Controlled Studies. Clin Neuropharmacol 2020; 43:107-111. [PMID: 32658036 DOI: 10.1097/wnf.0000000000000401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The efficacy of DFN-15 for pain control of migraine remains controversial. We conduct a systematic review and meta-analysis to explore the influence of DFN-15 versus placebo on pain control in migraine patients. PATIENTS AND METHODS We search PubMed, Embase, Web of Science, EBSCO, and Cochrane Library databases through November 2019 for randomized controlled trials assessing the effect of DFN-15 versus placebo on pain control in migraine patients. This meta-analysis is performed using the random-effects model. RESULTS Three randomized controlled trials are included in the meta-analysis. Overall, compared with the control group in migraine patients, lasmiditan treatment shows a positive impact on pain freedom at 2 hours (risk ratio [RR], 1.96; 95% confidence interval, 1.61-2.40; P < 0.00001), headache response at 2 hours (RR, 1.40; 95% CI, 1.25-1.57; P < 0.00001), and pain freedom at 24 hours (RR, 1.87; 95% CI, 1.33-2.62; P = 0.0003), but has no obvious influence or no substantial impact on no or mild disability level (RR, 1.21; 95% CI, 0.97-1.52; P = 0.09) or nausea (RR, 2.42; 95% CI, 0.53-11.01; P = 0.25). In addition, lasmiditan seems to result in the increase in dizziness (RR, 7.33; 95% CI, 1.83-29.30; P = 0.005) and paresthesia (RR, 5.17; 95% CI, 2.08-12.86; P = 0.0004). CONCLUSIONS DFN-15 treatment may be effective and safe for pain control in migraine patients.
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Affiliation(s)
- Yili Deng
- Department of Cardiology, Xinxin Hospital of Qijiang District
| | - Yang Chen
- Department of Neurology, Daping Hospital, Army Medical University, Chongqing, China
| | - Zeyan Peng
- Department of Neurology, Daping Hospital, Army Medical University, Chongqing, China
| | - Heng Yang
- Department of Neurology, Daping Hospital, Army Medical University, Chongqing, China
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Targeting Occipital Headache Pain: Preliminary Data Supporting an Alternative Approach to Occipital Nerve Block. Clin J Pain 2020; 36:289-295. [PMID: 31972707 DOI: 10.1097/ajp.0000000000000802] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND OBJECTIVES Occipital nerve block (ONB) is an effective procedure for treating occipital headache pain. However, traditional suboccipital approaches to ONB remain underutilized in acute and chronic settings. An alternative location for ONB is the superior nuchal line, where anatomic studies show a reliable relationship between the occipital artery (OA) and greater occipital nerve. This study evaluated the efficacy and validity of an alternative, single skin insertion, paresthesia-based approach to block both the greater and lesser occipital nerve. MATERIALS AND METHODS Patients with a clinical diagnosis of occipital headache were included in this study. External landmarks of the cervical spinous process and ipsilateral tragus were used to predict the location of the OA pulse at the superior nuchal line. Alternative ONB technique was used to block both the greater and lesser occipital nerves using single skin insertion and paresthesia confirmation. Demographic data, preprocedure, and postprocedure pain scores were collected, along with the incidence of procedural outcomes, including OA pulse palpation, paresthesia, and postprocedure numbness. RESULTS Data were obtained prospectively from 50 patients. Mean pain scores for the sample decreased by 54.64% postprocedure (P<0.001). Greater occipital nerve paresthesia was confirmed 90.0% on the left (95% confidence interval [CI]: 76.3-97.2) and 90.9% on the right side (95% CI: 78.3-97.5). Postprocedure numbness in greater occipital nerve distribution was reported 80.6% on left (95% CI: 64.0-91.8) and 90% on right (95% CI: 76.3-97.2). DISCUSSION The results suggest that this alternative approach to ONB effectively reduces occipital headache pain and reliably predicts OA pulse and related greater occipital nerve location as confirmed by paresthesia.
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Schwarz HB, Robbins MS. Are Two Head(ache)s Better Than One: Consequences of Diagnosing Migraine and Occipital Neuralgia. Neurol Clin Pract 2019; 11:1-2. [PMID: 33968465 DOI: 10.1212/cpj.0000000000000801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Heidi B Schwarz
- Department of Neurology (HBS), University of Rochester Medical Center, NY; and Department of Neurology (MSR), Weill Cornell Medical College, New York, NY
| | - Matthew S Robbins
- Department of Neurology (HBS), University of Rochester Medical Center, NY; and Department of Neurology (MSR), Weill Cornell Medical College, New York, NY
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Carvalho GF, Schwarz A, Szikszay TM, Adamczyk WM, Bevilaqua-Grossi D, Luedtke K. Physical therapy and migraine: musculoskeletal and balance dysfunctions and their relevance for clinical practice. Braz J Phys Ther 2019; 24:306-317. [PMID: 31813696 DOI: 10.1016/j.bjpt.2019.11.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/21/2019] [Accepted: 11/21/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Migraine is a primary headache with high levels of associated disability that can be related to a variety of symptoms and comorbidities. The role of physical therapy in the management of migraine is largely unknown. Therefore, the aim of this review is to highlight and critically discuss the current literature and evidence for physical therapy interventions in individuals with migraines. METHODS A narrative review of the literature was performed. RESULTS Physical therapists assessing and treating patients with migraine should focus on two primary aspects: (1) musculoskeletal dysfunctions, and (2) vestibular symptoms/postural control impairment. Signs and symptoms of musculoskeletal and/or vestibular dysfunctions are prevalent among individuals with migraines and different disability levels can be observed depending on the presence of aura or increment of the migraine attacks. CONCLUSION A proper physical examination and interview of the patients will lead to a tailored treatment plan. The primary aim regarding musculoskeletal dysfunctions is to reduce pain and sensitization, and physical therapy interventions may include a combination of manual therapy, exercise therapy, and education. The aim regarding postural control impairment is to optimize function and reduce vestibular symptoms, and interventions should include balance exercises and vestibular rehabilitation. However, consistent evidence of benefits is still lacking due to the lack of and therefore need for tailored and pragmatic clinical trials with high methodological quality.
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Affiliation(s)
- Gabriela Ferreira Carvalho
- Medical Section, Department of Orthopedics and Trauma Surgery, Academic Physiotherapy, Pain and Exercise Research, University of Luebeck, Luebeck, Germany; Department of Systems Neuroscience, University of Hamburg-Eppendorf, Hamburg, Germany; Department of Health Sciences, Ribeirão Preto Medical School, Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Annika Schwarz
- Department of Health Sciences, Ribeirão Preto Medical School, Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Tibor Maximilian Szikszay
- Medical Section, Department of Orthopedics and Trauma Surgery, Academic Physiotherapy, Pain and Exercise Research, University of Luebeck, Luebeck, Germany
| | - Waclaw Marceli Adamczyk
- Medical Section, Department of Orthopedics and Trauma Surgery, Academic Physiotherapy, Pain and Exercise Research, University of Luebeck, Luebeck, Germany; Laboratory of Pain Research, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Débora Bevilaqua-Grossi
- Department of Health Sciences, Ribeirão Preto Medical School, Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Kerstin Luedtke
- Medical Section, Department of Orthopedics and Trauma Surgery, Academic Physiotherapy, Pain and Exercise Research, University of Luebeck, Luebeck, Germany; Laboratory of Pain Research, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland.
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Amirlak B, Chung MH, Masrour S. Commentary on: Cost-Utility Analysis of Surgical Decompression Relative to Injection Therapy for Chronic Migraine Headaches. Aesthet Surg J 2019; 39:NP471-NP473. [PMID: 31504133 DOI: 10.1093/asj/sjz198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Bardia Amirlak
- Department of Plastic Surgery and Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX
| | - Michael H Chung
- Department of Plastic Surgery and Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX
| | - Shamin Masrour
- Department of Plastic Surgery and Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX
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Weatherall MW, Nandi D. Percutaneous electrical nerve stimulation (PENS) therapy for refractory primary headache disorders: a pilot study. Br J Neurosurg 2019; 33:608-612. [DOI: 10.1080/02688697.2019.1671951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
| | - Dipankar Nandi
- Department of Neurosurgery, Charing Cross Hospital, Imperial College NHS Healthcare, London, UK
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Greater Occipital Nerve Block for the Treatment of Chronic Migraine Headaches: A Systematic Review and Meta-Analysis. Plast Reconstr Surg 2019; 144:943-952. [PMID: 31568309 DOI: 10.1097/prs.0000000000006059] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Few treatment options exist for chronic migraine headaches, with peripheral nerve blocks having long been used to reduce the frequency and severity of migraines. Although the therapeutic effects have been observed in clinical practice, the efficacy has never been fully studied. In the past decade, however, several randomized controlled clinical trials have been conducted to assess the efficacy of greater occipital nerve block in the treatment of chronic migraine headaches. METHODS A systematic review of the literature was performed in the citation databases PubMed, Embase, MEDLINE, and the Cochrane Library. The initial search of databases yielded 259 citations, of which 33 were selected as candidates for full-text review. Of these, nine studies were selected for inclusion in this meta-analysis. RESULTS Studies were analyzed that reported mean number of headache days per month in both intervention and control groups. A total of 417 patients were studied, with a pooled mean difference of -3.6 headache days (95 percent CI, -1.39 to -5.81 days). This demonstrates that greater occipital nerve block intervention significantly reduced the frequency of migraine headaches compared with controls (p < 0.00001). Pooled mean difference in pain scores of -2.2 (95 percent CI, -1.56 to -2.84) also demonstrated a significant decrease in headache severity compared with controls (p < 0.0121). CONCLUSIONS Greater occipital nerve blocking should be recommended for use in migraine patients, particularly those that may require future surgical intervention. The block may act as an important stepping stone for patients experiencing migraine headache because of its usefulness for potentially assessing surgical candidates for nerve decompression. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
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Tajti J, Szok D, Nyári A, Vécsei L. Therapeutic strategies that act on the peripheral nervous system in primary headache disorders. Expert Rev Neurother 2019; 19:509-533. [DOI: 10.1080/14737175.2019.1615447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- János Tajti
- Department of Neurology, Faculty of Medicine, Interdisciplinary Excellence Centre, University of Szeged, Szeged, Hungary
| | - Délia Szok
- Department of Neurology, Faculty of Medicine, Interdisciplinary Excellence Centre, University of Szeged, Szeged, Hungary
| | - Aliz Nyári
- Department of Neurology, Faculty of Medicine, Interdisciplinary Excellence Centre, University of Szeged, Szeged, Hungary
| | - László Vécsei
- Department of Neurology, Faculty of Medicine, Interdisciplinary Excellence Centre, University of Szeged, Szeged, Hungary
- MTA-SZTE Neuroscience Research Group of the Hungarian Academy of Sciences, Szeged, Hungary
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Noseda R, Melo-Carrillo A, Nir RR, Strassman AM, Burstein R. Non-Trigeminal Nociceptive Innervation of the Posterior Dura: Implications to Occipital Headache. J Neurosci 2019; 39:1867-1880. [PMID: 30622169 PMCID: PMC6407291 DOI: 10.1523/jneurosci.2153-18.2018] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/08/2018] [Accepted: 12/27/2018] [Indexed: 12/28/2022] Open
Abstract
Current understanding of the origin of occipital headache falls short of distinguishing between cause and effect. Most preclinical studies involving trigeminovascular neurons sample neurons that are responsive to stimulation of dural areas in the anterior 2/3 of the cranium and the periorbital skin. Hypothesizing that occipital headache may involve activation of meningeal nociceptors that innervate the posterior ⅓ of the dura, we sought to map the origin and course of meningeal nociceptors that innervate the posterior dura overlying the cerebellum. Using AAV-GFP tracing and single-unit recording techniques in male rats, we found that neurons in C2-C3 DRGs innervate the dura of the posterior fossa; that nearly half originate in DRG neurons containing CGRP and TRPV1; that nerve bundles traverse suboccipital muscles before entering the cranium through bony canals and large foramens; that central neurons receiving nociceptive information from the posterior dura are located in C2-C4 spinal cord and that their cutaneous and muscle receptive fields are found around the ears, occipital skin and neck muscles; and that administration of inflammatory mediators to their dural receptive field, sensitize their responses to stimulation of the posterior dura, peri-occipital skin and neck muscles. These findings lend rationale for the common practice of attempting to alleviate migraine headaches by targeting the greater and lesser occipital nerves with anesthetics. The findings also raise the possibility that such procedures may be more beneficial for alleviating occipital than non-occipital headaches and that occipital migraines may be associated more closely with cerebellar abnormalities than in non-occipital migraines.SIGNIFICANCE STATEMENT Occipital headaches are common in both migraine and non-migraine headaches. Historically, two distinct scenarios have been proposed for such headaches; the first suggests that the headaches are caused by spasm or tension of scalp, shoulders, and neck muscles inserted in the occipital region, whereas the second suggests that these headaches are initiated by activation of meningeal nociceptors. The current study shows that the posterior dura overlying the cerebellum is innervated by cervicovascular neurons in C2 DRG whose axons reach the posterior dura through multiple intracranial and extracranial pathways, and sensitization of central cervicovascular neurons from the posterior dura can result in hyper-responsiveness to stimulation of neck muscles. The findings suggest that the origin of occipital and frontal migraine may differ.
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Affiliation(s)
- Rodrigo Noseda
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02115
| | - Agustin Melo-Carrillo
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02115
| | - Rony-Reuven Nir
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02115
| | - Andrew M Strassman
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02115
| | - Rami Burstein
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02115
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Inan LE, Inan N, Unal-Artık HA, Atac C, Babaoglu G. Greater occipital nerve block in migraine prophylaxis: Narrative review. Cephalalgia 2019; 39:908-920. [DOI: 10.1177/0333102418821669] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objectives The importance and popularity of peripheral nerve block procedures have increased in the treatment of migraine. Greater occipital nerve (GON) block is a commonly used peripheral nerve block method, and there are numerous researches on its use in migraine treatment. Materials and methods A search of PubMed for English-language randomized controlled trials (RCT) and open studies on greater occipital nerve block between 1995 and 2018 was performed using greater occipital nerve, headache, and migraine as keywords. Results In total, 242 potentially relevant PubMed studies were found. A sum of 228 of them which were non-English articles and reviews, case reports, letters and meta-analyses were excluded. The remaining articles were reviewed, and 14 clinical trials, seven of which were randomized-controlled on greater occipital nerve block in migraine patients, were identified and reviewed. Conclusions Although clinicians commonly use greater occipital nerve block in migraine patients, the procedure has yet to be standardized. The present study reviewed the techniques, drugs and dosages, the frequency of administration, side effects, and efficacy of greater occipital nerve block in migraine patients.
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Affiliation(s)
- Levent Ertugrul Inan
- Ministry of Health Ankara Research and Training Hospital, Neurology Clinic, Ankara, Turkey
- Bozok University, Medical School, Neurology Department, Yozgat, Turkey
| | - Nurten Inan
- Gazi University Medical School, Anesthesiology and Algology Department, Ankara, Turkey
| | | | - Ceyla Atac
- Ministry of Health Izmir Bozkaya Research and Training Hospital, Neurology Clinic, Izmir, Turkey
| | - Gulcin Babaoglu
- Ministry of Health Ankara Research and Training Hospital, Algology Clinic, Ankara, Turkey
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Blake P, Nir RR, Perry CJ, Burstein R. Tracking patients with chronic occipital headache after occipital nerve decompression surgery: A case series. Cephalalgia 2018; 39:556-563. [PMID: 30217120 DOI: 10.1177/0333102418801585] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The therapeutic benefit of nerve decompression surgeries for chronic headache/migraine are controversial. AIM To provide clinical characteristics of headache type and treatment outcome of occipital nerve decompression surgery. METHODS A retrospective review of clinical records. Inclusion criteria were evidence of chronic occipital headache with and without migrainous features and tenderness of neck muscles, occipital allodynia, and inadequate response to prophylactic drugs. RESULTS Surgical decompression of the greater and lesser occipital nerves provided complete and extended (3-6 years) relief of new daily persistent headache in case 3 (46 year old female), and of chronic post-traumatic headache in cases 4 and 6 (35 and 30 year old females, respectively), partial relief of chronic headache/migraine in cases 1 and 2 (41 year old female and 36 year old male), and no relief of episodic (cases 3 and 4) or chronic migraine (case 5, 52 year old male), or chronic tension-type headache (case 7, 31 year old male). CONCLUSIONS As a case series, this study cannot test a hypothesis or determine cause and effect. However, the complete elimination of new daily persistent headache and post-traumatic headache, and the partial elimination of chronic headache/migraine in two patients - all refractory to other treatment approaches - supports and justifies the effort to continue to generate data that can help determine whether decompression nerve surgeries are beneficial in the treatment of certain types of chronic headache.
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Affiliation(s)
- Pamela Blake
- 1 Headache Center of Greater Heights, Memorial Hermann Greater Heights Hospital, Houston, TX, USA
| | - Rony-Reuven Nir
- 2 Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- 3 Harvard Medical School, Boston, MA, USA
| | | | - Rami Burstein
- 2 Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- 3 Harvard Medical School, Boston, MA, USA
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Korucu O, Dagar S, Çorbacioglu ŞK, Emektar E, Cevik Y. The effectiveness of greater occipital nerve blockade in treating acute migraine-related headaches in emergency departments. Acta Neurol Scand 2018; 138:212-218. [PMID: 29744871 DOI: 10.1111/ane.12952] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2018] [Indexed: 01/03/2023]
Abstract
OBJECTIVE 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. METHOD 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 45 minutes with a 10-point pain scale score (PSS). RESULTS 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). CONCLUSION 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.
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Affiliation(s)
- O. Korucu
- Department of Neurology; University of Health Sciences; Kecioren Training and Research Hospital; Ankara Turkey
| | - S. Dagar
- Department of Emergency Medicine; University of Health Sciences; Kecioren Training and Research Hospital; Ankara Turkey
| | - Ş. K. Çorbacioglu
- Department of Emergency Medicine; University of Health Sciences; Kecioren Training and Research Hospital; Ankara Turkey
| | - E. Emektar
- Department of Emergency Medicine; University of Health Sciences; Kecioren Training and Research Hospital; Ankara Turkey
| | - Y. Cevik
- Department of Emergency Medicine; University of Health Sciences; Kecioren Training and Research Hospital; Ankara Turkey
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