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

Casas-Limón, Javier; Aledo‐Serrano, Ángel; Abarrategui, Belén; Cuadrado, María‐Luz

doi:10.1111/head.12607

Cited by 5 publications

(3 citation statements)

References 14 publications

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“…A large body of evidence points towards cortical spreading depression (CSD) as the fundamental electrophysiological phenomenon behind migraine aura (17–19). It might be that the modulation of the trigeminal-cervical complex is capable of interrupting CSD and therefore aura (13,15). However, it may well be that GON block has no direct influence on CSD, and that the effect seen on aura has more to do with the suppression of other factors involved in migraine.…”

Section: Discussionmentioning

confidence: 99%

“…GON block also appears to have an effect during the acute phase, causing a decrease in pain, allodynia and photophobia (8)(9)(10)(11)(12). To date, only three cases of hemiplegic migraine and a case of brainstem migraine have been reported in which a rapid suppression of aura was obtained after GON block (13)(14)(15). With this open, non-controlled pilot study we aimed to describe the response to GON blocks in a prospective series of patients with prolonged or persistent migraine aura.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2016

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2016

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“…In addition to helping with migraine‐related pain, GON blocks may be helpful for migraine aura. There have been several case reports of patients who received GON blocks during an active migraine aura, including one with prolonged hemiplegic migraine aura and another with brainstem aura who experienced improvement in both the headache and neurologic symptoms within 5–15 min after GON block, with resolution of aura in 1 h 52,53 . Baron et al report a similar case of migraine with brainstem aura and left>right suboccipital tenderness who noted dramatic improvement of headache, photophobia, phonophobia, nausea, visual changes, imbalance, and speech difficulties within several minutes of a left GON block 54 .…”

Section: Indications For Nerve Blocksmentioning

confidence: 99%

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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Guía consenso sobre técnicas de infiltración anestésica de nervios pericraneales

et al. 2017

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

Abstract: GON blockade may be an effective option for the acute treatment of hemiplegic aura or other prolonged migraine auras.

Cited by 5 publications

References 14 publications

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

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

Narrative review of peripheral nerve blocks for the management of headache

Guía consenso sobre técnicas de infiltración anestésica de nervios pericraneales

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