https://doi.org/10.4081/cc.2024.15770

Efficacy and safety of greater occipital nerve block with a small volume of lidocaine and methylprednisolone in tertiary headache center

Vol. 34 No. 2 (2024)
Submitted: 14 May 2024
Accepted: 13 June 2024
Published: 9 July 2024
Greater occipital nerve, nerve block, migraine, cluster headache, cervicogenic headache
Abstract Views: 1462
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Authors

Chiara Rosignoli
https://orcid.org/0009-0003-5241-9655
Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, Coppito, Italy.
Agnese Onofri
https://orcid.org/0000-0002-9697-0970
Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, Coppito, Italy.
Federico De Santis
https://orcid.org/0000-0002-8059-6427
Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, Coppito, Italy.
Simona Sacco
Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, Coppito, Italy.
Raffaele Ornello
raffaele.ornello@univaq.it
Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, Coppito, Italy.

Background: The greater occipital nerve block (GON-B) is used in clinical practice for treating different forms of headache. There is no standardized procedure to perform GON-B. This study evaluates the efficacy and feasibility of a low-volume GON-B protocol utilizing a pre-mixed solution of lidocaine (10 mg) and methylprednisolone (40 mg) across various headache disorders.
Methods: This observational case series included patients receiving their first GON-B from November 2019 to February 2021. Participants were diagnosed with migraine, cluster headache, cervicogenic headache, or paroxysmal hemicrania. The primary outcome was the degree of response to the GON-B.
Results: Thirty-nine patients with migraine underwent a first GON-B. Regarding headache frequency, 26% achieved substantial response and 33% partial response. For headache intensity, 26% reported substantial and 49% partial improvement. Migraine patients experienced a significant reduction in median monthly headache days from 25 to 13 (p=0.001) and in headache intensity from a median of 8 to 6 on the Numerical Rating Scale (NRS) scale (p<0.001). Of the 27 patients receiving a second GON-B, 33% had a substantial response, 48% a partial response, and 19% no response. Results from subsequent sessions were consistent with these findings. Ten patients with cluster headache underwent GON-B, showing a significant reduction in pain intensity from a median NRS score of 10 to 5 (p=0.008). Two patients with cervicogenic headache showed a partial response to GON-B, with pain intensity decreasing from 8 to 6 and 8 to 7 over 30 monthly episodes. A patient with paroxysmal hemicrania received seven GON-B injections, reducing daily attacks from 30 to 10 and pain intensity from 7 to 6 on the NRS scale.
Conclusions: These outcomes affirm GON-B potential in interrupting pain pathways, even at a low dose, in a wide range of headache disorders.

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How to Cite

1.
Rosignoli C, Onofri A, De Santis F, Sacco S, Ornello R. Efficacy and safety of greater occipital nerve block with a small volume of lidocaine and methylprednisolone in tertiary headache center. Confinia Cephalal [Internet]. 2024 Jul. 9 [cited 2024 Nov. 21];34(2). Available from: https://www.confiniacephalalgica.com/site/article/view/15770
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