Greater Occipital Nerve Blockade for Cluster Headache

Peres, Mario F. P.; Stiles, Marlind Alan; Siow, HC; Rozen, Todd D.; Young, William B.; Silberstein, Stephen D.

doi:10.1046/j.1468-2982.2002.00410.x

Cited by 193 publications

(143 citation statements)

References 6 publications

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“…We cannot exclude the possibility that the end of the CH attacks merely coincided with the time of the GON-blocking injection, though it is highly unlikely as the frequency of the attacks was increasing and the CH symptoms ended within minutes of the injection. As reported by Roze 10 , the blockade procedure itself (needle insertion) may provoke CH symptomatology; in the patient we describe, the GON blockade was instead extremely effective in relieving the CH pain as described in previous studies 16,17 . Peres et al after greater occipital nerve blocked in cluster patients reported 28.5% good response, 35.7% a moderate and 35.7% of the cases no response over the pain control 17 .…”

Section: Discussionsupporting

confidence: 63%

“…As reported by Roze 10 , the blockade procedure itself (needle insertion) may provoke CH symptomatology; in the patient we describe, the GON blockade was instead extremely effective in relieving the CH pain as described in previous studies 16,17 . Peres et al after greater occipital nerve blocked in cluster patients reported 28.5% good response, 35.7% a moderate and 35.7% of the cases no response over the pain control 17 . The presence of both excitatory and inhibitory trigeminocervical convergence mechanisms may provide a clinical explanation in our patient 11 .…”

Section: Discussionsupporting

confidence: 63%

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Occipital neuroma triggered cluster headache responding to greater occipital nerve blockade

Stani

Piovesan

Scattoni

et al. 2008

Arq. Neuro-Psiquiatr.

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6 , though they may provide limited relief in some cases; moreover, some patients become steroid-dependent and develop serious steroid-related adverse effects within months. CH is marked by its circadian rhythmicity. Episodic cluster periods start at the same time each year, occur at the same time each day and the duration of each CH is almost the same for every attack. These clinical features, along with the hormonal alterations documented in CH patients, suggest that the hypothalamus plays a role in the genesis of CH. PET studies by May et al. 7 , revealed hypothalamic activation during CH attacks, supporting the hypothesis of hypothalamic involvement. The concept of the hypothalamus acting as a CH generator has also been entertained 8 . However, not all CH patients present the same symptoms, nor do all respond to the same medications, which suggests that atypical or even non-hypothalamic forms of CH may exist. Although the cervico-occipital onset of CH is not contemplated by the International Headache Diagnostic Criteria II-version (IHDC -II), it is not uncommon to find patients with this painful symptomatology in clinical practice. Anatomical and clinical data suggest that the greater occipital nerve (GON) may trigger pain that has the typical cluster characteristics and is associated with the autonomic symptoms noted in CH. Sensory neurons in the trigeminocervical complex receive ipsilateral and contralateral input from the GON 9 . We describe an atypical cluster headache with trigeminal symptoms that improve after the blocked of the greater occipital nerve in one patient with occipital neuroma. caseA 37-year-old woman came to the Headache Unit in our Pain Center in December 2005. She had a positive past medical history for migraine without aura. In March 2005, two weeks after a neck soft tissue trauma, she started experiencing daily headache attacks without periodicity. Each attack lasted from 30 to 120 min and occurred in the afternoons or evenings, with an average frequency of four attacks per day. The pain, which was always unilateral (right-sided), invariably started in the right occipital region and subsequently spread to the right eye and frontal region (Figure). The pain was severe and squeezing in nature, and was associated with right-eye ptosis, unilateral right-sided lacrimation and rhinorrhea (Figure). The pain was not associated with nausea, vomiting or phono-photophobia. During the attacks the patient was restless, rocking her head and body while standing or sitting.Oxygen and sumatriptan (subcutaneous 6 mg) were inconstantly effective, while NSAIDs did not provide any pain relief. The patient reported that the most effective pain control mechanism prior to referral to our Headache Unit had been the application of digital pressure to the right occipital region of the neck during the attacks. Preventive monotherapies (verapamil, valproate and steroids) previously prescribed by other physicians had been ineffective.Both the general and neurological examinations were normal, apart from the ...

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Section: Discussionsupporting

confidence: 63%

Section: Discussionsupporting

confidence: 63%

Occipital neuroma triggered cluster headache responding to greater occipital nerve blockade

Stani

Piovesan

Scattoni

et al. 2008

Arq. Neuro-Psiquiatr.

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“…We suggest the use of this therapy on patients with oxygenand sumatriptan-resistant CH attacks in the ED and in patients who complain of sumatriptan side effects or have contraindications to triptans [5,6].…”

Section: Lorena Scattoni Fabrizio DI Stani Veronica Villani Demo Dugomentioning

confidence: 99%

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

et al. 2006

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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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“…Some open label and uncontrolled studies (Peres et al 2002;Afridi et al 2006) and a double-blind placebo-controlled trial (Ambrosini et al 2005) now support the efficacy of GON block. A mixture of the local anesthetic lidocaine and a corticosteroid, such as betamethasone (Ambrosini et al 2005), triamcinolone (Peres et al 2002) and methylprednisolone (Afridi et al 2006), is generally injected. The efficacy of the injection does not seem to be related to the lidocaine in the solution, but rather to the corticosteroid (Anthony 1985;Ambrosini et al 2005).…”

Section: B Greater Occipital Nerve Blockadementioning

confidence: 96%