Greater occipital nerve block efficacy in COVID‑19 associated headache: a preliminary study

COVID‑19 is an infection caused by the new coronavirus SARS‑CoV‑2. Headache is one of the most common neurological findings. In the treatment of various chronic headaches, the greater occipital nerve (GON) block is often used as a safe and effective method. The aim of our study was to investigate the effectiveness of the GON block in the treatment of headaches observed in COVID‑19 patients. Between March and May 2020, 27 patients (with laboratory‑confirmed 2019‑nCoV infection by next‑generation sequencing confirmation of real‑time PCR) that had moderate or severe headache associated with COVID‑19 and treated with a single session of GON block were retrospectively analyzed. The visual analogue scale (VAS) values and the number of analgesic usage of patients were recorded before and after the blockade on the 1st and 10th days. Fifteen (55.6%) patients included in the study were male and twelve (44.4%) were female. In terms of VAS values, the difference between pre‑treatment and post‑treatment values on the 1st and 10th days was found statistically significant. Likewise, the difference between analgesic use before and after the procedure was statistically significant. GON block appears to be an effective pain management method in COVID‑19 related headache, and it revealed promising reductions in pain scores and analgesic usage. As well as we know, this is the first study of “COVID‑19 associated headache treated with GON blockade”. More long term and well‑designed prospective studies with more participants are needed to better define this headache and develop effective treatment strategies.

Greater occipital nerve block efficacy in COVID‑19 associated headache: a preliminary study

COVID‑19 is an infection caused by the new coronavirus SARS‑CoV‑2. Headache is one of the most common neurological findings. In the treatment of various chronic headaches, the greater occipital nerve (GON) block is often used as a safe and effective method. The aim of our study was to investigate the effectiveness of the GON block in the treatment of headaches observed in COVID‑19 patients. Between March and May 2020, 27 patients (with laboratory‑confirmed 2019‑nCoV infection by next‑generation sequencing confirmation of real‑time PCR) that had moderate or severe headache associated with COVID‑19 and treated with a single session of GON block were retrospectively analyzed. The visual analogue scale (VAS) values and the number of analgesic usage of patients were recorded before and after the blockade on the 1st and 10th days. Fifteen (55.6%) patients included in the study were male and twelve (44.4%) were female. In terms of VAS values, the difference between pre‑treatment and post‑treatment values on the 1st and 10th days was found statistically significant. Likewise, the difference between analgesic use before and after the procedure was statistically significant. GON block appears to be an effective pain management method in COVID‑19 related headache, and it revealed promising reductions in pain scores and analgesic usage. As well as we know, this is the first study of "COVID‑19 associated headache treated with GON blockade". More long term and well‑designed prospective studies with more participants are needed to better define this headache and develop effective treatment strategies.

The investigation into the cutaneous silent period in patients with essential tremor pre-treatment and post-treatment

Although essential tremor (ET) is the most common movement disorder, little is known regarding its pathophysiology. Cutaneous silent period (CSP) is a spinal inhibitory reflex that causes suppression of the voluntary muscle contraction that is induced by strong electrical stimulation of the cutaneous nerves. Clinical interest in the CSP stems from its potential usefulness for evaluating segment and components of sensory nerves that are not well assessed by standard electrodiagnostic methods. The aim of this study was to investigate CSP in patients with ET before and after treatment. A total of 30 patients (12 females + 18 males), having ET diagnosis and propranolol treatment initiated, were studied with technique of CSP. Patient group's pre-treatment latency average is found 84.45 ± 18.63, average CSP duration 42.37 ± 11.82, and CSP final latency average 127.10 ± 19.13. According to post-treatment CSP analysis, it is seen that patients' average latency values are found 83.14 ± 20.92 and it is determined that there is no significant statistical difference compared to pre-treatment latency values (p > 0.05). Post-treatment average CSP duration is found 36.64 ± 13.38, and it is seen that there is a significant statistical shortening compared to pre-treatment durations (p < 0.05). Patients' post-treatment CSP final latency averages are found 123.17 ± 13.67, and it is determined that there is no significant statistical difference compared to pre-treatment latency values (p > 0.05). The main finding of this study is that in ET the CSP is prolonged and that treatment with propranolol shortens the CSP and brings it closer to normal values. A small dose of propranolol has the effect of shortening pathologically prolonged CSP in a subset of ET patients (women and without family history), making further investigations with this method interesting. From this point of view in our study, patients with ET treatment give an idea of the effectiveness of propranolol. In recent years, a technique of CSP is interested in the field of electrophysiology and shows the effect of ET that given other pharmacological treatment and also it can be considered a quantitative measure to compare them. The usefulness of CSP should be supported by further studies with more patients.