A comparison of the clinical efficacy of GON block at the C2 level and GON block at the classical distal occipital level in the treatment of migraine

Karaoğlan, Mustafa; İnan, Levent Ertuğrul

doi:10.1016/j.clineuro.2022.107190

Cited by 10 publications

(27 citation statements)

References 24 publications

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“…Many studies have proven that GON blockade is an effective treatment method for migraine. 25,26,27 The rationale for using a GON block in headache treatment is derived from evidence of the convergence of sensory input to the trigeminal nucleus caudalis neurons from both cervical and trigeminal fibres 28,29 , and its role in antagonising a putative "wind-up-like effect," which may explain the headache improvement. 30 Although there is no standard procedure for GON blockade, the nerve is usually blocked with a mixture of local anaesthetic and corticosteroid using a blind technique.…”

Section: Discussionmentioning

confidence: 99%

Using GON block as a diagnostic block: Investigation of clinical efficacy of GON radiofrequency treatment for migraine patients

Karaoğlan¹,

Küçükçay²

2022

NeuroAsia

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Objective: This retrospective study aimed to investigate the clinical efficacy of GON pulsed radiofrequency (PRF) treatment in migraine patients who did not respond adequately to treatment with greater occipital nerve (GON) blockade. Method: Twenty-seven patients with recurrent episodic migraines or chronic migraines were included in the study. GON blockade was performed bilaterally once a week – four times over a one-month duration. PRF treatment was performed once for those patients who did not show an adequate response to GON blockade, and the treatment was directed at the same sites as the GON blockade. The number of migraine attacks in the preceding 30 days, the total number of triptan tablets taken, the average duration of headache and the highest VAS scores at the first, third and sixth-month visits were recorded. Results: The number of severe migraine attacks, total analgesic use and the maximum duration of migraine episodes were recorded in this study. All these parameters showed a significant decrease from the first month after GON PRF treatment as compared to both the baseline as well as to treatment one month after GON block. In addition, this clinical improvement was sustained up to six months after PRF treatment. Conclusion: Our results suggest that GON PRF treatment is a viable treatment approach in the case of migraine patients who do not respond adequately to treatment with GON blockade.

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Section: Discussionmentioning

confidence: 99%

Using GON block as a diagnostic block: Investigation of clinical efficacy of GON radiofrequency treatment for migraine patients

Karaoğlan¹,

Küçükçay²

2022

NeuroAsia

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“…1,3,36,37 Another method uses distance from the occipital protuberance, typically 1.5-2 cm lateral and 2-3 cm inferior. 4,30,[38][39][40] Clinicians can also palpate for the occipital artery pulse about 2 cm lateral to the occipital protuberance. The occipital nerve is often, but not always, just medial to the artery.…”

Section: Greater Occipital Nerve Blockmentioning

confidence: 99%

“…Flamer et al compared outcomes between proximal and distal ultrasound‐guided GON nerve blocks in a CM cohort and found that while both techniques had similar short‐term efficacy, there was a greater likelihood of sustained pain relief at 1 and 3 months with the more proximal block 95 . Karaoglan and Inan 40 looked at patients with EM or CM in their retrospective review and found that 1 month of weekly ultrasound‐guided GON blocks performed distally or proximally at C2 both provided significant improvement in migraine frequency and severity at the first and third months, compared to baseline ( p < 0.001; frequency of injections confirmed by personal communication, M. Karaoglan, March 19, 2022). In both treatment groups, headache severity, frequency, and analgesic use were improved compared to baseline, but the blocks at the C2 level were associated with a greater reduction in severe monthly migraine attacks compared to distal blocks.…”

Section: Lessons Learned From the Literaturementioning

confidence: 99%

“…In both treatment groups, headache severity, frequency, and analgesic use were improved compared to baseline, but the blocks at the C2 level were associated with a greater reduction in severe monthly migraine attacks compared to distal blocks. Adverse events were higher in the C2‐level injections ( p = 0.006), but all adverse events were transient, with a subset of patients in the C2 group noted to have transient dizziness or cerebellar symptoms such as ataxia (25%), while a number of patients treated with distal blocks had transient worsening of headache (12.9%) 40 …”

Section: Lessons Learned From the Literaturementioning

confidence: 99%

“…Five patients have been reported to develop an acute cerebellar syndrome after GON blocks. 40,100,101 One patient with a Chiari malformation and possible excessive anterolateral neck flexion during positioning was reported to have needle penetration and injection of local anesthetic and non-steroidal anti-inflammatory drugs into the cerebellar tonsils. 100 The other four were receiving injections at the C2 level and described unilateral dysmetria, dysdiadochokinesia, and ataxic gait for about 4-6 h after their procedure.…”

Section: Adverse Effects Of Nerve Blocks?mentioning

confidence: 99%

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Narrative review of peripheral nerve blocks for the management of headache

et al. 2022

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Objective: To provide an overview of the current available literature on peripheral nerve blocks for the management of migraine and other headache disorders in adults.Background: Peripheral nerve blocks have been commonly performed in the headache practice for migraine, cluster headache, occipital neuralgia, and other headache disorders, despite a paucity of evidence supporting their use historically. In the past decade, there has been an effort to explore the efficacy and safety of peripheral nerve blocks for the management of headache, with the greatest interest centered around greater occipital blocks. Design:We performed a search in PubMed using key words including "occipital nerve blocks," "peripheral nerve blocks," "occipital nerve," "migraine," "cluster headache," and "neuralgia." We reviewed the randomized controlled trials (RCTs), observational studies, and case series, and summarized the anatomy, techniques, and the evidence for the use of peripheral nerve blocks in different headache disorders, with particular focus on available RCTs. Case reports were included for a detail review of adverse events.Results: Of 12 RCTs examining the use of greater occipital nerve blocks for migraine, all but one demonstrate efficacy with reduction in headache frequency, intensity, and/or duration compared to placebo. Studies have not demonstrated a difference in clinical outcomes with the use of corticosteroids for nerve blocks compared to blocks with local anesthetic in the treatment of migraine. There are two RCTs supporting the use of greater occipital blockade for cluster headache, both showing benefit of suboccipitally injected corticosteroid. One RCT suggests benefit of greater occipital nerve blocks for cervicogenic headache. Observational studies and case series/reports show that greater occipital nerve block may be effective in prolonged migraine aura, status migrainosus, post-dural puncture headache, and occipital neuralgia. Overall, peripheral nerve blocks are well tolerated. Serious side effects are rare but have been reported, including acute cerebellar syndrome and infection.Conclusions: Peripheral nerve blocks, especially occipital nerve blocks, are a viable treatment option for migraine and may be helpful in cluster headache as a transitional therapy or rescue therapy.

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