Acute Treatment of Basilar‐Type Migraine With Greater Occipital Nerve Blockade

Baron, Eric P.; Tepper, Stewart J.; Mays, MaryAnn; Cherian, Neil

doi:10.1111/j.1526-4610.2010.01682.x

Cited by 18 publications

(9 citation statements)

References 14 publications

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“…In our patient, GON blockade was followed by rapid and complete resolution of the aura symptoms, just as occurred to the prior cases of hemiplegic and brainstem migraine auras published by Rozen 7 and Baron et al 8 It could have been natural history that the aura stopped, but most likely it was the procedure that stopped the aura. Indeed, all her previously untreated auras lasted about 5 hours, and this one ceased in less than 2 hours.…”

Section: Discussionsupporting

confidence: 71%

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Greater Occipital Nerve Blockade: A Safe and Effective Option for the Acute Treatment of Hemiplegic Aura

et al. 2015

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Section: Discussionsupporting

confidence: 71%

“…So far, only two case reports have described cessation of these episodes with this procedure. 7,8 We present a new case of rapid alleviation of the motor and sensory aura symptoms after GON blockade.…”

mentioning

confidence: 99%

Greater Occipital Nerve Blockade: A Safe and Effective Option for the Acute Treatment of Hemiplegic Aura

et al. 2015

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“…The goal of acute treatment is to achieve sustained pain free response, that is, to be pain free in 2 h time of the acute treatment and also in 24 h [42][43][44][45][46]. Simple analgesics such as paracetamol, acetylsalicylic acid, antiemetic drugs such as metoclopramide, NSAIDs, triptans can be used in acute treatment [45,[47][48][49].…”

Section: Acute Treatmentmentioning

confidence: 99%

Prevalence of Migraine in the Elderly: A Narrated Review

2019

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Migraine is one of the most prevalent neurological disorders among all age groups including the elderly, but the incidence and prevalence of migraine tend to decrease with age. The clinical phenotype of migraine also appears to be different in the elderly patient group in comparison to the younger patient group, with elderly migraine appearing to be more often bilateral and associated with what has become known as “late-life migraine accompaniments. Furthermore, difficulty in the differentiation of migraine from vascular insults such as transient ischemic attacks and amyloid angiopathy and other multiple comorbidities, polypharmacy and age-related changes in pharmacodynamics and pharmacokinetics makes treatments for this cohort challenging but necessary, especially given the worldwide increase in life expectancy, and likelihood of migraine continuing to be a major personal and public health problem.

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“…GONB has been reported anecdotally to alleviate symptoms in patients with hemiplegic migraine and basilar type migraine. 17,18 Overall, the results of the majority, but not all, of the above studies support efficacy of GONB in the treatment of migraine and some other headaches. The extent and duration of the therapeutic effect of GONB varied among studies, and this may have been related to the variation in drug regimens used, injection technique, and treatment protocols.…”

Section: Expert Opinionmentioning

confidence: 86%

“…GONB has been reported anecdotally to alleviate symptoms in patients with hemiplegic migraine and basilar type migraine …”

Section: Expert Opinionmentioning

confidence: 99%

Occipital and Trigeminal Nerve Blocks for Migraine

2015

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To block or not to block, that is the question. CLINICAL HISTORIESCase 1.-This is a 53-year-old male seen for consultation due to headaches since high school, which have been almost daily for the past 20 years. He describes a throbbing pain behind the left eye, with an intensity of 5-9/10 and posterior cervical pressure, occasionally associated with nausea and vomiting, but no light or sound sensitivity. He takes rizatriptan 10 mg daily, and the headache is gone in about 1 hour. Every couple of weeks, the headache recurs and he takes another dose of rizatriptan. He takes hydrocodone 1-2 tablets every couple of weeks. Alcohol triggers his headaches. Sumatriptan injections and baclofen did not help. He has tried topiramate, amitriptyline, divalproex sodium, gabapentin, and propranolol for headache prevention, without help. He also tried onabotulinumtoxinA once, without help. Chiropractic treatment did not help. He has not tried acupuncture. Magnetic resonance imaging of the brain with and without contrast, done 3 months previously, was negative. He has a past medical history of hyperlipidemia, treated with a statin. Neurological examination was normal. There was bilateral greater occipital nerve (GON) tenderness. Bilateral greater occipital nerve block (GONB) was performed by injection of 3 mL of 1% lidocaine 2 cm lateral and 2 cm inferior to the inion on each side. For headache prevention, he was started on zonisamide 100 mg daily for 2 weeks and then 200 mg daily. He was informed on the risk of medication overuse headache with frequent use of rizatriptan. He was seen in follow-up 2 months later. During the 2 weeks after the occipital nerve blocks (ONBs), he had one headache that was quickly relieved by rizatriptan. For the following 14 days, he experienced headaches once every other day, and thereafter his daily headache pattern resumed, with prompt relief by rizatriptan.Case 2.-This is a 45-year-old woman with a 15-year history of migraine without aura occurring about 2-3 times per month. She takes eletriptan 40 mg tablets, with relief of the headache in 2 hours. She presents with a 2-day history of a typical right-sided throbbing headache of 9/10 intensity, associated with nausea, vomiting, as well as light and sound sensitivity. Her symptoms did not respond to 2 doses of eletriptan and promethazine suppository. A right GONB was performed by injection of 3 mL of 1% lidocaine 2 cm lateral and 2 cm inferior to the inion, with relief of the headache within 10 minutes. Subsequently, she has had 2 similar episodes that were quickly relieved by ONBs.Case 3.-This is a 58-year-old male seen in consultation with headaches since high school, which have been daily for the past month. Prior to that, he had approximately 4 headache days per week for many years. He describes a bilateral retro-orbital and temporal pain with nuchal-occipital throbbing and pres-

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Acute Treatment of Basilar‐Type Migraine With Greater Occipital Nerve Blockade

Cited by 18 publications

References 14 publications

Greater Occipital Nerve Blockade: A Safe and Effective Option for the Acute Treatment of Hemiplegic Aura

Greater Occipital Nerve Blockade: A Safe and Effective Option for the Acute Treatment of Hemiplegic Aura

Prevalence of Migraine in the Elderly: A Narrated Review

Occipital and Trigeminal Nerve Blocks for Migraine

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