Greater occipital nerve block for the acute treatment of prolonged or persistent migraine aura

Abstract

Background Presently, there is no evidence to guide the acute treatment of migraine aura. We aimed to describe the effect of greater occipital nerve (GON) anaesthetic block as a symptomatic treatment for long-lasting (prolonged or persistent) migraine aura. Methods Patients who presented with migraine aura lasting > 2 hours were consecutively recruited during one year at the Headache Unit and the Emergency Department of a tertiary hospital. All patients underwent a bilateral GON block with bupivacaine 0.5%. Patients were followed up for 24 hours. Results A total of 22 auras were treated in 18 patients. Auras consisted of visual ( n = 13), visual and sensory ( n = 4) or sensory symptoms alone ( n = 5). Eleven episodes met diagnostic criteria for persistent aura (>1 week) without infarction. The response was complete without early recurrence in 11 cases (50%), complete with recurrence in < 24 hours in two cases (9.1%), and partial with ≥ 50% improvement in six cases (27.3%). Complete responses without recurrence were more common in cases with prolonged auras lasting < 1 week than in those with persistent auras (72.7% vs. 27.3%; p = 0.033). Conclusions GON block could be an effective symptomatic treatment for prolonged or persistent migraine aura. Randomised controlled trials are still required to confirm these results.

A Randomized, Sham‐Controlled Trial of Bilateral Greater Occipital Nerve Blocks With Bupivacaine for Acute Migraine Patients Refractory to Standard Emergency Department Treatment With Metoclopramide

“…Randomized studies of GONB for migraine to date have assessed the role of steroids as adjunctive therapy or focused on short‐term migraine prevention . In published case series, post‐procedure outcomes have generally been substantially better than those reported here . Among a series of 18 patients with acute migraine with prolonged aura who received bilateral GONB, 55% reported complete pain relief and 25% partial pain relief .…”

“…12,16 In published case series, post-procedure outcomes have generally been substantially better than those reported here. 17,18 Among a series of 18 patients with acute migraine with prolonged aura who received bilateral GONB, 55% reported complete pain relief and 25% partial pain relief. 18 Among a series of 19 patients with episodic or transformed migraine and brush allodynia who received a GONB with trigger point injection, 89% reported reduction in pain 20 minutes later.…”

“…17,18 Among a series of 18 patients with acute migraine with prolonged aura who received bilateral GONB, 55% reported complete pain relief and 25% partial pain relief. 18 Among a series of 19 patients with episodic or transformed migraine and brush allodynia who received a GONB with trigger point injection, 89% reported reduction in pain 20 minutes later. 17 However, in a retrospective database review of 562 patients who received GONB for an acute migraine in a clinic setting, results were similar to those reported here: 82% of patients had a ≥30% response to GONB and 58% reported ≥50% response.…”

Coining the Pablo Picasso Syndrome

“…The study was small, as it only included 31 patients for efficacy analysis, and further investigation was not pursued . Bilateral occipital nerve blocks have also shown to provide some relief with aura symptoms …”

The effectiveness of greater occipital nerve blockade in treating acute migraine-related headaches in emergency departments

“…To our knowledge, the only publication in the literature in- and a full response was achieved in 11 cases (55%). 21 Our study is the first to evaluate the effectiveness of a GON blockade in acute migraine treatment at an ED in a randomized and controlled manner. All of our patients were evaluated at the ED, and the GON blockades were applied there, too.…”