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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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Byun S, Pather N. Pediatric regional anesthesia: A review of the relevance of surface anatomy and landmarks used for peripheral nerve blockades in infants and children. Clin Anat 2019; 32:803-823. [DOI: 10.1002/ca.23406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/08/2019] [Accepted: 05/09/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Sarang Byun
- Department of AnatomySchool of Medical Sciences, Medicine, UNSW Sydney Sydney Australia
| | - Nalini Pather
- Department of AnatomySchool of Medical Sciences, Medicine, UNSW Sydney Sydney Australia
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Shauly O, Gould DJ, Patel KM. The Public's Perception of Interventions for Migraine Headache Disorders: A Crowdsourcing Population-Based Study. AESTHETIC SURGERY JOURNAL OPEN FORUM 2019; 1:ojz007. [PMID: 33791603 PMCID: PMC7670936 DOI: 10.1093/asjof/ojz007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Migraine disorders are a leading cause of morbidity and decreased economic productivity
in the United States among both men and women. As such, it is important to consider
patient opinions, and have an accurate representation of the burden and sentiment toward
currently available interventions among those suffering from migraines. Objectives The aim of the study was to assess patient options regarding adverse outcomes of the
various treatment options available for migraine headaches. Methods A prospective cross-sectional study of volunteers recruited through an internet
crowdsourcing service, Amazon Mechanical Turk©, was conducted. Surveys were administered
to collect patient-reported opinions regarding adverse outcomes of both surgical and
nonsurgical treatment options for migraine headaches. Results The prevalence of migraine headache across all study participants was 15.6% and varied
slightly across participant demographics. Individuals ages 35–44 (2.73 migraines per
month) experienced the fewest migraine and with the lowest severity. Those individuals
ages 45+ experienced the most severe headaches (Visual Analog Scale = 44.23 mm).
Additionally, the greatest migraine frequency and severity existed among those
households with yearly income of $75,000–$100,000. The lowest injection therapy utility
scores were obtained for adverse outcomes of hematoma (47.60 mm) and vertigo (54.40
mm). Conclusions Migraine headaches remains a significant problem among the US population, with an
overall prevalence of 15.6% (approximately 50 million Americans). Additionally,
physicians interesting in offering minimally invasive or surgical treatment for migraine
headaches should focus on mitigating patient fears regarding clinical outcomes and cost
of care.
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Affiliation(s)
- Orr Shauly
- Keck Hospital of University of Southern California, Los Angeles, CA
| | - Daniel J Gould
- Keck Hospital of University of Southern California, Los Angeles, CA
| | - Ketan M Patel
- Keck Hospital of University of Southern California, Los Angeles, CA
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Yanuck J, Shah S, Jen M, Dayal R. Occipital Nerve Blocks in the Emergency Department for Initial Medication-Refractory Acute Occipital Migraines. Clin Pract Cases Emerg Med 2019; 3:6-10. [PMID: 30775654 PMCID: PMC6366379 DOI: 10.5811/cpcem.2019.1.39910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 12/06/2018] [Accepted: 01/01/2019] [Indexed: 01/03/2023] Open
Abstract
Migraines are consistently among the top 20 primary coded diagnoses in emergency departments, constituting 4.5% of all chief complaints. In a significant subset of these, pain arises from the occipital region innervated by the greater (GON) and lesser occipital nerve. In this case series, we present three patients with occipital migraines who received GON blockade with 1% lidocaine. The blockade was performed only after first-line treatment with metoclopramide and possibly additional medications as ordered by triage physician, failed to adequately alleviate pain by 40 minutes after medication administration. Patients were contacted a minimum of seven days following treatment. All three patients experienced significant analgesia and relief of symptoms within 15 minutes of blockade and sustained relief through a seven-day follow-up period.
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Affiliation(s)
- Justin Yanuck
- University of California, Irvine, Department of Emergency Medicine, Orange, California
| | - Sagar Shah
- University of California, Irvine, Department of Emergency Medicine, Orange, California
| | - Maxwell Jen
- University of California, Irvine, Department of Emergency Medicine, Orange, California
| | - Rakhi Dayal
- University of California, Irvine, Department of Anesthesiology, Orange, California
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Friedman BW, Mohamed S, Robbins MS, Irizarry E, Tarsia V, Pearlman S, John Gallagher E. A Randomized, Sham-Controlled Trial of Bilateral Greater Occipital Nerve Blocks With Bupivacaine for Acute Migraine Patients Refractory to Standard Emergency Department Treatment With Metoclopramide. Headache 2018; 58:1427-1434. [DOI: 10.1111/head.13395] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 06/07/2018] [Accepted: 06/19/2018] [Indexed: 12/18/2022]
Affiliation(s)
- Benjamin W. Friedman
- Department of Emergency Medicine; Albert Einstein College of Medicine, Montefiore Health System; Bronx NY USA
- Department of Physician Assistant Studies; York College, City University of New York; Jamaica NY
| | - Sajid Mohamed
- Department of Emergency Medicine; Albert Einstein College of Medicine, Montefiore Health System; Bronx NY USA
| | - Matthew S. Robbins
- Department of Neurology; Montefiore Headache Center; Albert Einstein College of Medicine; Montefiore Health System; Bronx NY USA
| | - Eddie Irizarry
- Department of Emergency Medicine; Albert Einstein College of Medicine, Montefiore Health System; Bronx NY USA
| | - Valerie Tarsia
- Department of Emergency Medicine; Albert Einstein College of Medicine, Montefiore Health System; Bronx NY USA
| | - Scott Pearlman
- Department of Emergency Medicine; Albert Einstein College of Medicine, Montefiore Health System; Bronx NY USA
| | - E. John Gallagher
- Department of Emergency Medicine; Albert Einstein College of Medicine, Montefiore Health System; Bronx NY USA
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Yanuck J, Nelson A, Jen M. Use of occipital nerve block in emergency department treatment of status migrainosus. Am J Emerg Med 2018; 36:1321.e1-1321.e3. [PMID: 29678293 DOI: 10.1016/j.ajem.2018.03.054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 03/20/2018] [Indexed: 12/28/2022] Open
Abstract
Migraine headaches make up a significant proportion of emergency department visits. There are multiple pharmacologic treatment modalities for migraine abortive therapy; however, these treatments are rarely targeted to the precise area of pain and thus elicit multiple systemic effects. It has been well established in the anesthesia pain literature that occipital nerve blocks can provide not only immediate pain relief from occipital migraines, but can also result in a long-term resolution of occipital migraines. In this case report, we present how an occipital nerve block in the emergency department resulted in immediate and long-lasting resolution of a patient's occipital migraine.
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Affiliation(s)
| | | | - Maxwell Jen
- University of California, Irvine, United States
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Christie SD, Kureshi N, Beauprie I, Holness RO. Occipital osteomylelitis and epidural abscess after occipital nerve block: A case report. Can J Pain 2018; 2:57-61. [PMID: 35005366 PMCID: PMC8730567 DOI: 10.1080/24740527.2017.1360725] [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] [Indexed: 12/04/2022]
Abstract
Occipital neuralgia is a paroxysmal jabbing pain in the distribution of the greater or lesser occipital nerves accompanied by diminished sensation in the affected area. Occipital nerve block is a common diagnostic and therapeutic tool used in the course of occipital neuralgia and is considered a safe treatment with few localized adverse events. Occipital nerve block is also indicated for cervicogenic and cluster headache and is often used as a rescue treatment for headaches not responding to conventional therapies. We describe a case of epidural abscess formation 16 days following occipital nerve block in a patient with no underlying medical conditions. This case report emphasizes the importance of strict aseptic technique to reduce infection rates in patients undergoing this procedure, despite the overall safety of occipital nerve block. Clinicians must remain aware of acute and late complications arising postprocedure for the safe practice of this technique.
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Affiliation(s)
- Sean D Christie
- Division of Neurosurgery, Dalhousie University/QEII Health Sciences Centre, Halifax, NS, Canada
| | - Nelofar Kureshi
- Division of Neurosurgery, Dalhousie University/QEII Health Sciences Centre, Halifax, NS, Canada
| | - Ian Beauprie
- Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University/QEII Health Sciences Centre, Halifax, NS, Canada
| | - Renn O Holness
- Cornwall Regional Hospital, University of the West Indies, The University of the West Indies, Mona, Jamaica
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Santos Lasaosa S, Cuadrado Pérez M, Guerrero Peral A, Huerta Villanueva M, Porta-Etessam J, Pozo-Rosich P, Pareja J. Consensus recommendations for anaesthetic peripheral nerve block. NEUROLOGÍA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.nrleng.2016.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Santos Lasaosa S, Cuadrado Pérez M, Guerrero Peral A, Huerta Villanueva M, Porta-Etessam J, Pozo-Rosich P, Pareja J. Guía consenso sobre técnicas de infiltración anestésica de nervios pericraneales. Neurologia 2017; 32:316-330. [DOI: 10.1016/j.nrl.2016.04.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 04/22/2016] [Indexed: 12/20/2022] Open
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Abstract
Primary headache is a common malady that is often under-recognized and frequently inadequately managed in spite of the fact that it affects up to 95 % of the population in a lifetime. Many forms of headache, including episodic tension and migraine headaches, if properly diagnosed, are reasonably amenable to treatment, but a smaller, though not insignificant, percent of the population suffer daily from a chronic, intractable form of headache that destroys one's productivity and quality of life. These patients are frequently seen in neurological practices at a point when treatment options are limited and largely ineffective. In the following review, we will discuss mechanisms drawn from recent studies that address the transition from acute to chronic pain that may apply to the transformation from episodic to chronic daily headaches which may offer opportunities for preempting headache transformation.
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Ruiz Piñero M, Mulero Carrillo P, Pedraza Hueso M, de la Cruz Rodríguez C, López Mesonero L, Guerrero Peral A. Bloqueo anestésico de nervios pericraneales como tratamiento preventivo de migraña: experiencia en una serie de 60 pacientes. Neurologia 2016; 31:445-51. [DOI: 10.1016/j.nrl.2014.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 09/10/2014] [Accepted: 10/10/2014] [Indexed: 01/03/2023] Open
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Uyar Türkyilmaz E, Eryilmaz NC, Güzey NA, Moraloğlu Ö. Bloqueio bilateral do nervo occipital maior para tratamento de cefaleia pós‐punção dural após cesarianas. Braz J Anesthesiol 2016; 66:445-50. [DOI: 10.1016/j.bjan.2015.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 03/23/2015] [Indexed: 10/21/2022] Open
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Pericranial nerve blockade as a preventive treatment for migraine: Experience in 60 patients. NEUROLOGÍA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.nrleng.2016.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
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Uyar Türkyilmaz E, Camgöz Eryilmaz N, Aydin Güzey N, Moraloğlu Ö. Bilateral greater occipital nerve block for treatment of post-dural puncture headache after caesarean operations. Braz J Anesthesiol 2016; 66:445-50. [PMID: 27591456 DOI: 10.1016/j.bjane.2015.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 03/12/2015] [Accepted: 03/23/2015] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Post-dural puncture headache (PDPH) is an important complication of neuroaxial anesthesia and more frequently noted in pregnant women. The pain is described as severe, disturbing and its location is usually fronto-occipital. The conservative treatment of PDPH consists of bed rest, fluid theraphy, analgesics and caffeine. Epidural blood patch is gold standard theraphy but it is an invasive method. The greater occipital nerve (GON) is formed of sensory fibers that originate in the C2 and C3 segments of the spinal cord and it is the main sensory nerve of the occipital region. GON blockage has been used for the treatment of many kinds of headache. The aim of this retrospective study is to present the results of PDPH treated with GON block over 1 year period in our institute. METHODS 16 patients who had been diagnosed to have PDPH, and performed GON block after caesarean operations were included in the study. GON blocks were performed as the first treatment directly after diagnose of the PDPH with levobupivacaine and dexamethasone. RESULTS The mean VAS score of the patients was 8.75 (±0.93) before the block; 3.87 (±1.78) 10min after the block; 1.18 (±2.04) 2h after the block and 2.13 (±1.64) 24h after the block. No adverse effects were observed. CONCLUSIONS Treatment of PDPH with GON block seems to be a minimal invasive, easy and effective method especially after caesarean operations. A GON block may be considered before the application of a blood patch.
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Affiliation(s)
- Esra Uyar Türkyilmaz
- Zekai Tahir Burak Womens' Health Training and Research Hospital, Department of Anesthesiology and Reanimation, Ankara, Turkey.
| | - Nuray Camgöz Eryilmaz
- Zekai Tahir Burak Womens' Health Training and Research Hospital, Department of Anesthesiology and Reanimation, Ankara, Turkey
| | - Nihan Aydin Güzey
- Zekai Tahir Burak Womens' Health Training and Research Hospital, Department of Anesthesiology and Reanimation, Ankara, Turkey
| | - Özlem Moraloğlu
- Zekai Tahir Burak Womens' Health Training and Research Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey
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Voigt CL, Murphy MO. Occipital Nerve Blocks in the Treatment of Headaches: Safety and Efficacy. J Emerg Med 2015; 48:115-29. [DOI: 10.1016/j.jemermed.2014.09.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 05/13/2014] [Accepted: 09/02/2014] [Indexed: 11/27/2022]
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Watson DH, Drummond PD. Cervical Referral of Head Pain in Migraineurs: Effects on the Nociceptive Blink Reflex. Headache 2014; 54:1035-45. [DOI: 10.1111/head.12336] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2014] [Indexed: 12/16/2022]
Affiliation(s)
- Dean H. Watson
- School of Psychology; Murdoch University; Perth WA Australia
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Cho JCS, Haun DW, Kettner NW. Sonographic evaluation of the greater occipital nerve in unilateral occipital neuralgia. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2012; 31:37-42. [PMID: 22215767 DOI: 10.7863/jum.2012.31.1.37] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES Occipital neuralgia is a headache that may result from greater occipital nerve entrapment. Entrapped peripheral nerves typically have an increase in cross-sectional area. The purpose of this study was to measure the cross-sectional area and circumference of symptomatic and asymptomatic greater occipital nerves in patients with unilateral occipital neuralgia and to correlate the greater occipital nerve cross-sectional area with headache severity, sex, and body mass index. METHODS Both symptomatic and contralateral asymptomatic greater occipital nerve cross-sectional areas and circumferences were measured by a single examiner using sonography in 17 patients. The Wilcoxon signed rank test and Spearman rank order correlation coefficient were used to analyze the data. RESULTS Significant differences between the cross-sectional areas and circumferences of the symptomatic and asymptomatic greater occipital nerves were noted (P < .001). No difference existed in cross-sectional area (P = .40) or circumference (P = .10) measurements of the nerves between male and female patients. A significant correlation existed between the body mass index and symptomatic (r = 0.424; P = .045) and asymptomatic (r = 0.443; P = .037) cross-sectional areas. There was no correlation shown between the cross-sectional area of the symptomatic nerve and the severity of Headache Impact Test 6 scores (r = -0.342; P = .179). CONCLUSIONS We report sonographic evidence showing an increased cross-sectional area and circumference of the symptomatic greater occipital nerve in patients with unilateral occipital neuralgia.
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Affiliation(s)
- John Chin-Suk Cho
- Department of Radiology, Logan College of Chiropractic, Chesterfield, MO 63107, USA.
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Landy SH, Kaniecki RG, Taylor FR. Abstracts and Citations. Headache 2011. [DOI: 10.1111/j.1526-4610.2011.01950.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Na SH, Kim TW, Oh SY, Kweon TD, Yoon KB, Yoon DM. Ultrasonic doppler flowmeter-guided occipital nerve block. Korean J Anesthesiol 2010; 59:394-7. [PMID: 21253376 PMCID: PMC3022132 DOI: 10.4097/kjae.2010.59.6.394] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Revised: 04/16/2010] [Accepted: 07/21/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Greater occipital nerve block is used in the treatment of headaches and neuralgia in the occipital area. We evaluated the efficacy of ultrasonic doppler flowmeter-guided occipital nerve block in patients experiencing headache in the occipital region in a randomized, prospective, placebo-controlled study. METHODS Twenty-six patients, aged 18 to 70, with headache in the occipital region, were included in the study. Patients received a greater occipital nerve block performed either under ultrasonic doppler flowmeter guidance using 1% lidocaine or the traditional method. Sensory examination findings in the occipital region were evaluated. RESULTS The complete block rate of greater occipital nerve blockade in the doppler group was significantly higher than in the control group respectively (76.9% vs. 30.8%, P < 0.05). Only one patient in the control group had a complication (minimal bleeding). CONCLUSIONS Ultrasonic doppler flowmeter-guided occipital nerve block may be a useful method for patients suffering headache in the occipital region.
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Affiliation(s)
- Se Hee Na
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
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Nuss JE, Wanner LM, Tressler LE, Bavari S. The osmolyte trimethylamine N-oxide (TMAO) increases the proteolytic activity of botulinum neurotoxin light chains A, B, and E: implications for enhancing analytical assay sensitivity. ACTA ACUST UNITED AC 2010; 15:928-36. [PMID: 20720092 DOI: 10.1177/1087057110374996] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Botulism, the disease caused by botulinum neurotoxins (BoNTs), secreted by the spore-forming, anaerobic bacteria Clostridium botulinum, has been associated with food poisoning for centuries. In addition, the potency of BoNTs coupled with the current political climate has produced a threat of intentional, malicious poisoning by these toxins. The ability to detect and measure BoNTs in complex matrixes is among the highest research priorities. However, the extreme potency of these toxins necessitates that assays be capable of detecting miniscule quantities of these proteins. Thus, signal-boosting strategies must be employed. A popular approach uses the proteolytic activity of the BoNT light chain (LC) to catalyze the cleavage of synthetic substrates; reaction products are then analyzed by the analytical platform of choice. However, BoNT LCs are poor catalysts. In this study, the authors used the osmolyte trimethylamine N-oxide (TMAO) to increase the proteolytic activities of BoNT LCs. Their data suggest that concentrated solutions of TMAO induce complete folding of the LCs, resulting in increased substrate affinity and enhanced enzyme turnover. The authors observed increases in catalysis for BoNT serotypes A, B, and E, and this increased proteolytic activity translated into substantial increases in analytical assay sensitivity for these medically relevant toxins.
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Affiliation(s)
- Jonathan E Nuss
- US Army Medical Research Institute of Infectious Diseases, Frederick, MD 21702 , USA
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Nuss JE, Ruthel G, Tressler LE, Wanner LM, Torres-Melendez E, Hale ML, Bavari S. Development of cell-based assays to measure botulinum neurotoxin serotype A activity using cleavage-sensitive antibodies. ACTA ACUST UNITED AC 2009; 15:42-51. [PMID: 19965805 DOI: 10.1177/1087057109354779] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Botulinum neurotoxins (BoNTs) are zinc-metalloproteases that cleave components of the SNARE (soluble N-ethylmaleimide-sensitive factor attachment protein receptor) protein complex, inhibiting acetylcholine release into neuromuscular junctions, resulting in flaccid paralysis and eventual death. The potential for the malicious misuse of these toxins as bioweapons has created an urgent need to develop effective therapeutic countermeasures. Robust cell-based assays will be essential for lead identification and the optimization of therapeutic candidates. In this study, the authors developed novel BoNT serotype A (BoNT/A) cleavage-sensitive (BACS) antibodies that only interact with full-length SNAP-25 (synaptosomal-associated protein of 25 kDa), the molecular target of the BoNT/A serotype. These antibodies exhibit high specificity for full-length SNAP-25, allowing the BoNT/A-mediated proteolysis of this protein to be measured in diverse assay formats, including several variations of enzyme-linked immunosorbent assay and multiple immunofluorescence methods. Assays built around the BACS antibodies displayed excellent sensitivity, had excellent reproducibility, and were amenable to multiwell formats. Importantly, these assays provided novel methods for evaluating BoNT/A activity in cellular models of intoxication and allowed for the high-throughput evaluation of experimental compounds.
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Affiliation(s)
- Jonathan E Nuss
- US Army Medical Research Institute of Infectious Diseases, Frederick, Maryland 21702, USA
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Abstract
INTRODUCTION Occipital nerve block (ONB) is a promising treatment for headaches. Its indications, selection criteria, and best techniques are not clear, however. OBJECTIVE To summarize in narrative format what is known about ONBs and what needs to be learned. METHODS MD Consult and Google Scholar were searched using the terms occipital, suboccipital, block, and injection to identify relevant articles that were reviewed. This process was repeated for all additional pertinent articles identified from these articles, and so on, until no additional articles were identified. RESULTS A total of 21 articles were identified. CONCLUSIONS Occipital nerve block is an effective treatment for cervicogenic headache, cluster headache, and occipital neuralgia. While a double blinded randomized placebo controlled clinical trial is lacking, multiple open label studies reported favorable results for migraine. Two other possible uses of ONB worthy of further study are use as a rescue treatment and as an adjunctive treatment for medication overuse headache. ONB may be effective for tension headache, but only under very specific circumstances. ONB is either ineffective or only effective under as yet unstudied circumstances for hemicrania continua and chronic paroxysmal hemicrania. Some practitioners use occipital nerve (ON) tenderness to palpation (TTP) or reproduction of headache pain with ON pressure (RHPONP) as selection criteria for identifying appropriate patients. While only a clinical trial can produce a definitive answer, current evidence suggests that these selection criteria are not necessary for cervicogenic headache or cluster headache. Occipital neuralgia by definition involves TTP of the ONs. Whether RHPONP or ON TTP predicts success in migraine is unclear, and may relate to whether steroids are used. A single blinded randomized controlled trial evaluating local anesthetic with steroids vs local anesthetic alone for transformed migraine reported slightly worse results with steroids, but there are several alternate explanations for this finding other than steroids being counterproductive. The technique of repetitive ONBs deserves further study.
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Affiliation(s)
- Joshua Tobin
- 21st Century Neurology-Neurology, 2601 North Third Street, Phoenix, AZ 85004, USA
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Ailani J, Young WB. The role of nerve blocks and botulinum toxin injections in the management of cluster headaches. Curr Pain Headache Rep 2009; 13:164-7. [PMID: 19272284 DOI: 10.1007/s11916-009-0028-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Cluster headache (CH) is a primary headache syndrome that is classified with the trigeminal autonomic cephalalgias. CH treatment involves three steps: acute attack management, transitional therapy, and preventive therapy. Greater occipital nerve block has been shown to be an effective alternative bridge therapy to oral steroids in CH. Botulinum toxin type A has recently been studied as a new preventive treatment for patients with chronic CH, with limited success.
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Affiliation(s)
- Jessica Ailani
- Jefferson Headache Center, Gibbon Building, 111 South 11th Street, Suite 8130, Philadelphia, PA 19107, USA.
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