Occipital Nerve Blockade for Cervicogenic Headache: A Double‐Blind Randomized Controlled Clinical Trial

Abstract

Cervicogenic headache is a chronic hemicranial pain, usually occurring daily. This randomized, double-blind, placebo-controlled trial evaluated the effectiveness of nerve stimulator-guided occipital nerve blockade in the treatment of cervicogenic headache. The reduction in analgesic consumption was the primary outcome measure. Fifty adult patients diagnosed with cervicogenic headache were randomly divided into two equal groups of 25 patients each. All patients in both groups received greater and lesser occipital blocks, whereas only 16 patients in each group received facial nerve blockade in association with the occipital blocks. The control group received injections of an equivalent volume of preservative-free normal saline. Pain was assessed using the visual analog scale (VAS) and the Total Pain Index (TPI). Forty-seven patients entered into the final analysis as three patients were lost to follow-up. Anesthetic block was effective in reducing the VAS and the TPI by approximately 50% from baseline values (P = 0.0001). Analgesic consumption, duration of headache and its frequency, nausea, vomiting, photophobia, phonophobia, decreased appetite, and limitations in functional activities were significantly less in block group compared to control group (P < 0.05). The nerve stimulator-guided occipital nerve blockade significantly relieved cervicogenic headache and associated symptoms at two weeks following injection.

Headache and Neck

“…The greater occipital nerve can be easily blocked and serves as important diagnostic evidence if a temporary relief is obtained [81,82]. A greater occipital nerve block study in CeH showed significant improvement after 2 weeks [83]. The C3 level may be effectively blocked reducing the pain stemming from the C2-C3 zygapophysial joint [84].…”

Blocking the Greater Occipital Nerve: Utility in Headache Management

“…Naja et al [17] performed a double-blind, placebo-controlled trial of GONB with fentanyl, bupivacaine, clonidine, and lidocaine. The primary end point was analgesic consumption at 2 weeks, which was significantly lower for the lidocaine group than for the placebo group.…”

Interdisciplinary management of headache disorders

“…The lesser occipital nerve arises from the second cervical spinal nerve and sometimes the third and supplies sensation to the skin lateral to the GON and posterior to the greater auricular nerve. Blockade of these nerves with local anesthetic with or without steroids has been used to treat many different headache disorders including migraine, [96][97][98][99] cluster headache, 100-106 chronic daily headache, 100,107-109 hemicrania continua, 100,110 trigeminal neuralgia, 111 cervicogenic headache, 97,[112][113][114][115][116] and postdural puncture headache. 117,118 Although the results from most of the reported case series and studies are favorable, there is currently little convincing evidence for the efficacy of GON blockade in the acute or preventive treatment of headache, as most data on this topic come from noncontrolled studies.…”