Great occipital nerve blockade for cluster headache in the emergency department: case report

Abstract

IntroductionCluster headache (CH) is characterised by attacks of severe unilateral pain in the orbital, supraorbital and/or temporal areas, lasting from 15 up to 180 min, recurring up to 8 times daily and accompanied by ipsilateral autonomic symptoms. In the episodic form, headache attacks usually occur in bouts (cluster periods) lasting from one week to 1 year, separated by pain-free periods of at least 1 month. In the chronic form these pain-free periods are absent or last less than a month [1].Although effective acute treatments are available for CH attacks, e.g., subcutaneous sumatriptan injections, most patients need, in addition, preventative therapy. Several drugs, such as verapamil, methysergide and lithium carbonate, have proven efficacious in the prevention of CH attacks and shortening of bouts. Oral steroids are probably the most effective short-term preventative treatment [2], but patients may become steroid-dependent and develop serious steroid-related adverse effects within a few months.Anthony [3] shows that suboccipital injections of a local anaesthetic alone have neither a beneficial nor a J Headache Pain (2006) -006-0283-5 Great occipital nerve blockade for cluster headache in the emergency department: case report Abstract A 44-year-old man with a past medical history of episodic cluster headache presented in our ED with complaints of multiple daily cluster headache attacks, with cervico-occipital spreading of pain from May to September 2004. The neurological examination showed no abnormalities as well as brain and spine MRI. Great Occipital Nerve (GON) blockade, with Lidocaine 2% (5 ml) and betamethasone (2 mg), were performed in the right occipital region (ipsilaterally to cluster headache), during attack. GON blockade was effective immediately for the attack and the cluster period resolved after the injection. We suppose that the action of GON blockade may involve the trigemino-cervical complex and we moreover strongly suggest to use GON blockade in emergency departments for cluster headache with cervico-occipital spreading as attack abortive therapy, especially in oxygen and sumatriptan resistant cluster headache attacks, in patients who complaints sumatriptan side-effects or have contraindications to use triptans.7:98-100 DOI 10.1007/s10194

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“…28 Occipital neuralgia may present with other symptoms, including nausea, tinnitus, dizziness, and visual disturbance, symptoms that overlap with migraine and cluster headache. 29,30,31 Given the lack of diagnostic consensus, it becomes difficult to interpret the literature with regard to efficacy of various treatments. It seems increasingly apparent that these disorders exist along a continuum of headache pain that is likely multifactorial and interrelated (Fig.…”

Blocking the Greater Occipital Nerve: Utility in Headache Management

“…Studies have found GONB to be effective in migraine [9][10][11][12], cluster headache [4,13], posttraumatic headache [14], and in two cases of hemiplegic migraine, or attacks of migraine with unilateral motor symptoms [15,16].…”

Gamma Knife®Radiosurgery of the Trigeminal Nerve and Sphenopalatine Ganglion for Cluster Headache

“…Among these are interruption or decompression of the trigeminal tract, nerve, ganglion, roots, and nerves [24][25][26][27][28][29][30][31], interruption of the sympathetic pathways to the face [32], chemical or surgical interruption of the facial parasympathetic pathways to the face, including the nervus intermedius [27,33], greater super- fi cial petrosal nerve, and SPG [34][35][36][37][38]. Finally, stimulation, block and interruption of the vagus nerve [39], occipital nerve [40,41] and most recently deep brain stimulation within the posterior hypothalamus have brought some pain relief [42,43].…”