The efficacy of greater occipital nerve blockade in chronic migraine: A placebo-controlled study.

OBJECTIVE: GON blockade with local anesthetics is an effective treatment for a group of headaches, such as cervicogenic headache, cluster headache, occipital neuralgia, migraine. Our aim was to evaluate the efficacy of greater occipital nerve (GON) blockade in patients with chronic migraine (CM) by using a control group. MATERIALS AND METHODS: We included 44 CM patients and randomly divide the patients into two groups, as group A (bupivacaine) and group B (placebo) to our study. GON blockade was administered four times (once per week) with bupivacaine or saline. After 4 weeks of treatment, patients were followed up for 3 months, and findings were recorded once every month for comparing each month's values with the pretreatment values. The primary endpoint was the difference in the frequency of headache (headache days/month). VAS pain scores were also recorded. RESULTS: A total of 44 patients had completed the study; no severe adverse effects had occurred. Group A showed a significant decrease in the frequency of headache and VAS scores at the first, second, and third months of follow-up. Similarly, group B showed a significant decrease in the frequency of headache and VAS scores at the first month of follow-up, but second and third months of follow-up showed no significant difference. CONCLUSION: Our results suggest that GON blockade with bupivacaine was superior to placebo, has long-lasting effect than placebo, and was found to be effective for the treatment of CM. More studies are needed to better define the safety and cost-effectiveness of GON blockade in CM.

Greater occipital nerve block in the treatment of triptan-overuse headache: A randomized comparative study.

OBJECTIVES: This study aims to investigate the efficiency of a single and repeated greater occipital nerve (GON) block using lidocaine in the treatment of triptan-overuse headache (TOH), whose importance has increased lately. MATERIALS AND METHODS: In the study, 105 consecutive subjects diagnosed with TOH were evaluated. The subjects were randomized into three groups. In Group 1 (n=35), only triptan was abruptly withdrawn. In Group 2 (n=35), triptan was abruptly withdrawn and single GON block was performed. In Group 3 (n=35), triptan was abruptly withdrawn and three-stage GON block was performed. All patients were injected bilaterally with a total amount of 5 cc 1% lidocaine in each stage. During follow-up, the number of headache days per month, the severity of pain (VAS), the number of triptans used, and hsCRP and IL-6 levels were recorded three times; in the pretreatment period, in the second month post-treatment, and in the fourth month post-treatment. They were then compared. RESULTS: There was a statistically significant difference in the post-treatment fourth month in comparison with the pretreatment period in Group 3 (P<.05). Compared to Group 1, the number of headache days, VAS, and decrease in triptan need in Group 3 was statistically significant compared to Group 2 (P<.05). Compared to pretreatment, in the fourth month post-treatment, both hsCRP and IL-6 levels were lower only in Group 3 (P<.05). CONCLUSIONS: We are of the opinion that repeated GON block in addition to the discontinuation of medication has significant efficacy for TOH cases.