Background: Greater occipital never block has been shown to be an effective treatment in patients with cluster or tension type headache but there are very few studies investigating its effect in patients with chronic migraine. This study was to determine the effectiveness of greater occipital never block on headache in patients with chronic migraine. We designed an interventional before-after study for patients suffered from chronic migraine.
Methods: Patients were participated in this study according to inclusion and exclusion criteria. Frequency, severity and duration of headaches were recorded by patients 2 weeks before injection and then during 6 weeks after injection. We compared data recorded before injection to data from each two-week after injections to determine the effectiveness of greater occipital never block in improvement of headaches in patients with chronic migraine.
Results: Fourteen patients (mean age=34.21±2.75) were included in the study. Number of attacks was significantly decreased during 6 weeks follow up (p<0.05). Mean headache severity was significantly decreased during first and second two-week follow up by 3.04 and 2.39 points, respectively. Duration of headaches was not significantly reduced during follow up.
Conclusion: In conclusion, Greater occipital nerve block can improve the status of headache in patients with chronic migraine by decreasing the severity and frequency of headaches. However, it may not be effective in shortening the duration of headaches.
Goadsby PJ, Lipton RB, Ferrari MD. Migraine--current understanding and treatment. N Engl J Med. 2002;346(4):257-70.
Andlin-Sobocki P, Rossler W. Cost of psychotic disorders in Europe. Eur J Neurol. 2005;12 Suppl 1:74-7.
Olesen J, Steiner T. The International classification of headache disorders, 2nd edn (ICDH-II). Journal of Neurology, Neurosurgery & Psychiatry. 2004;75(6):808-11.
Wolff HG, Silberstein SD, Lipton RB, et al. Wolff's headache and other head pain: Oxford University Press, USA; 2001.
Headache disorders World Health Organization (WHO)
[cited 2007 December 3]; Available from: http://www.who.int/mediacentre/factsheets/fs277/en.
Scher AI, Stewart WF, Liberman J, Lipton RB. Prevalence of frequent headache in a population sample. Headache. 1998;38(7):497-506.
Silberstein SD, Lipton RB, Sliwinski M. Classification of daily and near-daily headaches: field trial of revised IHS criteria. Neurology. 1996;47(4):871-5.
Olesen J, Bousser MG, Diener HC, Dodick D, First M, Goadsby PJ, et al. New appendix criteria open for a broader concept of chronic migraine. Cephalalgia. 2006;26(6):742-6.
Munakata J, Hazard E, Serrano D, Klingman D, Rupnow MF, Tierce J, et al. Economic burden of transformed migraine: results from the American Migraine Prevalence and Prevention (AMPP) Study. Headache. 2009;49(4):498-508.
Lipton RB, Pan J. Is migraine a progressive brain disease? JAMA. 2004;291(4):493-4.
Natoli JL, Manack A, Dean B, Butler Q, Turkel CC, Stovner L, et al. Global prevalence of chronic migraine: a systematic review. Cephalalgia. 2010;30(5):599-609.
Bigal ME, Lipton RB. What predicts the change from episodic to chronic migraine? Curr Opin Neurol. 2009;22(3):269-76.
Blumenfeld AM, Varon SF, Wilcox TK, Buse DC, Kawata AK, Manack A, et al. Disability, HRQoL and resource use among chronic and episodic migraineurs: results from the International Burden of Migraine Study (IBMS). Cephalalgia. 2011;31(3):301-15.
Burstein R, Collins B, Jakubowski M. Defeating migraine pain with triptans: a race against the development of cutaneous allodynia. Ann Neurol. 2004;55(1):19-26.
Buse DC, Manack A, Serrano D, Turkel C, Lipton RB.. Sociodemographic and comorbidity profiles of chronic migraine and episodic migraine sufferers. J Neurol Neurosurg Psychiatry. 2010;81(4):428-32.
Pompili M, Di Cosimo D, Innamorati M, Lester D, Tatarelli R, Martelletti P. Psychiatric comorbidity in patients with chronic daily headache and migraine: a selective overview including personality traits and suicide risk. J Headache Pain. 2009;10(4):283-90.
Pompili M, Serafini G, Di Cosimo D, Dominici G, Innamorati M, Lester D, et al. Psychiatric comorbidity and suicide risk in patients with chronic migraine. Neuropsychiatr Dis Treat. 2010;6:81-91.
Silberstein SD, Goadsby PJ. Migraine: preventive treatment. Cephalalgia. 2002;22(7):491-512. Epub
Diener HC, Holle D, Dodick D. Treatment of chronic migraine. Curr Pain Headache Rep. 2011;15(1):64-9.
Ashkenazi A, Levin M, Dodick D. Peripheral procedures: Nerve blocks, peripheral neurostimulation and Botulinum neurotoxin injections. Wolff’s Headache and Other Head Pain. 2007:767-92.
Caputi CA, Firetto V. Therapeutic blockade of greater occipital and supraorbital nerves in migraine patients. Headache. 1997;37(3):174-9.
Gawel MJ, Rothbart PJ. Occipital nerve block in the management of headache and cervical pain. Cephalalgia. 1992;12(1):9-13.
Afridi SK, Shields KG, Bhola R, Goadsby PJ. Greater occipital nerve injection in primary headache syndromes--prolonged effects from a single injection. Pain. 2006;122(1-2):126-9.
Ambrosini A, Vandenheede M, Rossi P, Aloj F, Sauli E, Pierelli F, et al. Suboccipital injection with a mixture of rapid- and long-acting steroids in cluster headache: a double-blind placebo-controlled study. Pain. 2005;118(1-2):92-6.
Ashkenazi A, Young WB. The effects of greater occipital nerve block and trigger point injection on brush allodynia and pain in migraine. Headache. 2005;45(4):350-4.
Bovim G, Sand T. Cervicogenic headache, migraine without aura and tension-type headache. Diagnostic blockade of greater occipital and supra-orbital nerves. Pain. 1992;51(1):43-8.
Saadah HA, Taylor FB. Sustained headache syndrome associated with tender occipital nerve zones. Headache. 1987;27(4):201-5.
Ashkenazi A, Matro R, Shaw JW, Abbas MA, Silberstein SD. Greater occipital nerve block using local anaesthetics alone or with triamcinolone for transformed migraine: a randomised comparative study. J Neurol Neurosurg Psychiatry. 2008;79(4):415-7.
Cook B, Malik S, Shaw J, Oshinsky M, Young, W. Greater occipital nerve (GON) block successfully treats migraine within five minutes. Neurology. 2006;66:A42.
Gale GD. Re: Caputi CA, Firetto V. Therapeutic blockade of the greater occipital and supraorbital nerves in migraine patients. Headache. 1998;38(1):57.
Anthony M. Headache and the greater occipital nerve. Clin Neurol Neurosurg. 1992;94(4):297-301.
Peres M, Stiles M, Siow H, Rozen TD, Young WB, Silberstein SD. Greater occipital nerve blockade for cluster headache. Cephalalgia. 2002;22(7):520-2.
Scattoni L, Di Stani F, Villani V, Dugoni D, Mostardini C, Reale C, et al. Great occipital nerve blockade for cluster headache in the emergency department: case report. J Headache Pain. 2006;7(2):98-100.
Young WB. Blocking the greater occipital nerve: utility in headache management. Curr Pain Headache Rep. 2010;14(5):404-8.