Greater Occipital Nerve Treatment in the Management of Chronic Headache Secondary to Accidental Dural Puncture: A Case Report

Niraj, G.

doi:10.1111/head.13353

Cited by 5 publications

(17 citation statements)

References 6 publications

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“…15 This may support the hypothesis of central sensitization of the TNC, as the greater occipital nerve is the efferent arm of this circuit. Risk factors that may predispose to central sensitization of TNC include: persistent dural leak of CSF, history of migraine, history of persistent pain elsewhere in the body, a history of anxiety and or depression, and severe prolonged inadequately controlled PDPH.…”

Section: Discussionsupporting

confidence: 61%

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Incidence of Persistent Headache at 18 Months Following Accidental Dural Puncture in the Obstetric Population: A Prospective Service Evaluation in 45 Patients

et al. 2018

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Objective The aim of the prospective longitudinal service evaluation was to reveal the incidence of persistent headache at 18 months following accidental dural puncture with a 16‐gauge Tuohy needle. This followed an observation that a subset of female patients was presenting to the local pain medicine clinic with persistent headache following an accidental dural puncture. Background Two thirds of patients with an accidental dural puncture develop post dural puncture headache that is believed to be a self‐limiting condition. There is emerging evidence from retrospective studies that post dural puncture headache can result in persistent headache. Methods Prospective longitudinal service evaluation in obstetric patients who suffered an accidental dural puncture headache. Patients provided written consent for telephone follow‐up at 6, 12, and 18 months. Patients reporting persistent headache were reviewed at a pain medicine clinic for further investigations and management. Results Over an 18‐month period, 45 patients suffered accidental dural puncture. Five patients declined consent. One patient was lost to follow‐up. Of the 39 patients who completed follow‐up, 12 patients (30%) reported persistent headache at 18 months. Six patients reported new onset headache while 6 patients reported worsening of pre‐existing headache. Conclusion Post dural puncture headache from an accidental dural puncture can no longer be considered a self‐limiting condition. Current evidence probably mandates the addition of persistent headache as one of the potential complications of an epidural insertion during informed consent process.

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Section: Discussionsupporting

confidence: 61%

“…We have had some success with greater occipital nerve treatment in managing patients with persistent headaches following ADP. 15 This may support the hypothesis of central sensitization of the TNC, as the greater occipital nerve is the efferent arm of this circuit.…”

Section: Discussionsupporting

confidence: 61%

Incidence of Persistent Headache at 18 Months Following Accidental Dural Puncture in the Obstetric Population: A Prospective Service Evaluation in 45 Patients

et al. 2018

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“…The block of the greater occipital nerve (GON) is thought to be an effective treatment for acute migraine [ 67 ]. Furthermore, a recent case report describes its use in a patient presenting with persistent headaches following accidental dural puncture [ 68 ].…”

Section: Discussionmentioning

confidence: 99%

Retrospective Study on Ganglionic and Nerve Block Series as Therapeutic Option for Chronic Pain Patients with Refractory Neuropathic Pain

Gerken

Fritzsche

Denke

et al. 2020

Pain Research and Management

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Objective. Current recommendations controversially discuss local infiltration techniques as specific treatment for refractory pain syndromes. Evidence of effectiveness remains inconclusive and local infiltration series are discussed as a therapeutic option in patients not responding to standard therapy. The aim of this study was to investigate the effectiveness of infiltration series with techniques such as sphenopalatine ganglion (SPG) block and ganglionic local opioid analgesia (GLOA) for the treatment of neuropathic pain in the head and neck area in a selected patient group. Methods. In a retrospective clinical study, 4960 cases presenting to our university hospital outpatient pain clinic between 2009 and 2016 were screened. Altogether, 83 patients with neuropathic pain syndromes receiving local infiltration series were included. Numeric rating scale (NRS) scores before, during, and after infiltration series, comorbidity, and psychological assessment were evaluated. Results. Maximum NRS before infiltration series was median 9 (IQR 8–10). During infiltration series, maximum NRS was reduced by mean 3.2 points (SD 3.3, p<0.001) equaling a pain reduction of 41.0% (SD 40.4%). With infiltration series, mean pain reduction of at least 30% or 50% NRS was achieved in 54.2% or 44.6% of cases, respectively. In six percent of patients, increased pain intensity was noted. Initial improvement after the first infiltration was strongly associated with overall improvement throughout the series. Conclusion. This study suggests a beneficial effect of local infiltration series as a treatment option for refractory neuropathic pain syndromes in the context of a multimodal approach. This effect is both significant and clinically relevant and therefore highlights the need for further randomized controlled trials.

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“…Twenty‐five participants had a contrast‐enhanced MRI of the head; none showed any features consistent with intracranial hypotension. We suggest that short‐term cerebrospinal fluid loss and concomitant intracranial nociceptor activation leads to sensitisation of neurones in the trigeminocervical complex, unless the process is blocked or sufficiently limited early‐on with epidural blood patch [4–6, 16, 18, 26, 27].…”

Section: Discussionmentioning

confidence: 99%

Persistent headache and low back pain after accidental dural puncture in the obstetric population: a prospective, observational, multicentre cohort study

et al. 2021

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Summary Accidental dural puncture following epidural insertion can cause a post‐dural headache that is defined by the International Headache Society as self‐limiting. We aimed to confirm if accidental dural puncture could be associated with persistent headache and back pain when compared with matched control parturients. We performed a prospective multicentre cohort study evaluating the incidence of persistent headache following accidental dural puncture at nine UK obstetric units. Parturients who sustained an accidental dural puncture were matched with controls who had undergone an uneventful epidural insertion. Participants were followed‐up at six‐monthly intervals for 18 months. Primary outcome was the incidence of persistent headache at 18 months. Ninety parturients who had an accidental dural puncture were matched with 180 controls. The complete dataset for primary analysis was available for 256 (95%) participants. Incidence of persistent headache at 18 months was 58.4% (52/89) in the accidental puncture group and 17.4% (29/167) in the control group, odds ratio (95%CI) 18.4 (6.0–56.7), p < 0.001, after adjustment for past history of headache, Hospital Anxiety and Depression Scale (depression) and Hospital Anxiety and Depression Scale (anxiety) scores. Incidence of low back pain at 18 months was 48.3% (43/89) in the accidental puncture group and 17.4% (29/167) in the control group, odds ratio (95%CI) 4.14 (2.11–8.13), with adjustment. We have demonstrated that accidental dural puncture is associated with long‐term morbidity including persistent headache in parturients. This challenges the current definition of post‐dural puncture headache as a self‐limiting condition and raises possible clinical, financial and medicolegal consequences.

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Greater Occipital Nerve Treatment in the Management of Chronic Headache Secondary to Accidental Dural Puncture: A Case Report

Cited by 5 publications

References 6 publications

Incidence of Persistent Headache at 18 Months Following Accidental Dural Puncture in the Obstetric Population: A Prospective Service Evaluation in 45 Patients

Incidence of Persistent Headache at 18 Months Following Accidental Dural Puncture in the Obstetric Population: A Prospective Service Evaluation in 45 Patients

Retrospective Study on Ganglionic and Nerve Block Series as Therapeutic Option for Chronic Pain Patients with Refractory Neuropathic Pain

Persistent headache and low back pain after accidental dural puncture in the obstetric population: a prospective, observational, multicentre cohort study

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