Greater occipital nerve blockade for the preventive treatment of chronic migraine: A randomized double-blind placebo-controlled study

Abstract

Background Greater occipital nerve blockade for the prevention of chronic migraine has a limited evidence base. A robust randomized double-blind, placebo-controlled trial is needed. Methods This double-blind, placebo-controlled, parallel-group trial, following a baseline period of four weeks, randomly assigned patients of chronic migraine 1:1 to receive four-weekly bilateral greater occipital nerve blockade with either 2 ml of 2% (40 mg) lidocaine (active group) or 2 ml of 0.9% saline (placebo) injections for 12 weeks. The primary and key secondary efficacy endpoints were a change from the baseline in the mean number of headache and migraine days and the achievement of ≥50% reduction in headache days from baseline across the weeks 9–12 respectively. Safety evaluations included the documentation and reporting of serious and other adverse events. Results Twenty-two patients each were randomly allocated to the active and placebo group. Baseline demography and clinical characteristics were similar between the two groups. Mean headache and migraine days at baseline (±SD) were 23.4 ± 4.4 and 15.6 ± 5.7 days in the active group and 22.6 ± 5.0 and 14.6 ± 4.6 days in the placebo group respectively. The active group compared to the placebo had a significantly greater least-squares mean reduction in the number of headache and migraine days (−4.2 days [95% CI: −7.5 to −0.8; p = 0.018] and −4.7 days [95%CI: −7.7 to −1.7; p = 0.003] respectively). 40.9% of patients in the active group achieved ≥50% reduction in headache days as compared with 9.1% of patients receiving a placebo (p = 0.024). Overall, 64 mild and transient adverse events were reported by 16 patients in the active group and 15 in the placebo. No death or serious adverse events were reported. Conclusion Four-weekly greater occipital nerve blockade with 2% lidocaine for 12 weeks was superior to placebo in decreasing the average number of headache and migraine days in patients with chronic migraine with a good tolerability profile. Clinical trial.gov no. CTRI 2020/07/026709

Ultrasound‐guided stellate ganglion block for the treatment of migraine in elderly patients: A retrospective and observational study

“…It is well known that migraine can severely affect the patient's quality of life and even lead to headache‐related disabilities, especially with frequent and persistent attacks 18 . Therefore, the goal of migraine treatment is not only to decrease pain intensity, but also to reduce the frequency and duration of attacks, so that patients can return to healthy status and normal social activities 19,20 . In our study, pain intensity, headache frequency, and duration were effectively improved, suggesting that SGBs might provide a positive effect on the management of migraine in the elderly.…”

“…18 Therefore, the goal of migraine treatment is not only to decrease pain intensity, but also to reduce the frequency and duration of attacks, so that patients can return to healthy status and normal social activities. 19,20 In our study, pain intensity, headache frequency, and duration were effectively improved, suggesting that SGBs might provide a positive effect on the management of migraine in the elderly. It is worth noting that patients might take acute medications to alleviate headache when they experienced headache attacks, which may potentially affect the duration of headache; therefore, the conclusion that SGB may significantly reduce headache duration needs to be viewed with caution.…”

Comparison of Greater Occipital Nerve Blockade and Sphenopalatine Ganglion Blockade in Patients with Episodic Migraine

“…There have to date been more studies of GON block than SPG block. In randomized controlled trials, GON block has been found to reduce headache duration and intensity, as well as the number of headache days [ 16 , 18 ]. Chowdhury D et al reported that GON block with 2% lidocaine once a week for 4 weeks was superior to placebo in reducing the average number of headache days for 3 months in patients with chronic migraine [ 16 ].…”

“…Peripheral blocks as relatively inexpensive, easily applicable, and safe interventions can be applied in cases that fail to respond to medical treatment or that develop side effects. Several studies to date have described the application of blocks to the greater occipital nerve (GON) or sphenopalatine ganglion (SPG) for prophylactic treatment of migraine [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ].…”

Alternative and complementary treatments for migraine

“…Установлено значимое снижение частоты дней с мигренью у пациентов, получавших блокады БЗН, по сравнению с группой плацебо. Нежелательные явления с одинаковой частотой возникали в группах плацебо и лидокаина [66].…”