Suboccipital steroid injection alone as a preventive treatment for cluster headache

Gönen, Murat; Balgetir, Ferhat; Aytaç, Emrah; Taşçı, İrem; Demir, Caner Feyzi; Müngen, Bülent

doi:10.1016/j.jocn.2019.07.009

Cited by 12 publications

(19 citation statements)

References 26 publications

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“…Patients with MICCH reported a clinically relevant improvement after 69% of first GON-injections, 68% of second injections and 82% of third injections. These results are in line with other studies reporting response rates in mixed groups (ECH and CCH) between 42 and 96% [2,3,[5][6][7][8][9][10][11][12].…”

Section: Discussionsupporting

confidence: 93%

Repeated greater occipital nerve injections with corticosteroids in medically intractable chronic cluster headache: a retrospective study

et al. 2021

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Introduction Current prophylactic drugs for cluster headache are associated with limited efficacy, serious side effects and poor tolerability. Greater occipital nerve injection (GON-injection) has been proven effective and safe as a single, one-time injection in episodic (ECH), and to a lesser extent, chronic cluster headache (CCH). We aim to analyse the effectiveness and safety of repeated GON-injections in medically intractable chronic cluster headache (MICCH). Methods Clinical data of all cluster headache patients who had received at least one GON-injection between 2014 and 2018 in our tertiary headache centre were retrieved from patients’ medical records. Clinical history was taken as part of routine care shortly before and 6 weeks after GON-injection. Results We identified 47 MICCH patients (79 injections), and compared results with 22 non-MI CCH patients (30 injections) and 50 ECH patients (63 injections). Nineteen MICCH patients received repeated injections (32 in total, range 2–8). Rates of clinical relevant improvement to a first injection were similar in all groups (MICCH: 60%, non-MICCH 73%, ECH 76%; attack freedom: MICCH: 30%, non-MICCH 32%, ECH 43%). Furthermore, no difference in response to the first and second injection was shown between groups (all p > 0.29). Median effect duration in MICCH was 6 weeks (IQR 2.8–12 weeks). Side effects were only mild and local. Conclusion In this retrospective analysis, first and repeated GON-injections were well-tolerated and equally effective in MICCH as in non-MICCH, and ECH.

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Section: Discussionsupporting

confidence: 93%

Repeated greater occipital nerve injections with corticosteroids in medically intractable chronic cluster headache: a retrospective study

et al. 2021

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“…All these signals project centrally and converge to the trigeminal nucleus caudalis. Since GON is branch of the 2nd cervical root, its connection with the trigeminal nucleus interprets the positive effect of PRF on the control of migraine crises (18)(19)(20).…”

Section: Discussionmentioning

confidence: 99%

“…There are no cases described in literature with application of PRF on the occipital nerves for the management of clusters, but only PRF of the sphenopalatine ganglion. However, there are various published case series indicating that injection of high-volume local anesthetic with corticosteroid on the occipital nerves at the side of the cluster may lead to a preventive effect (18,(20)(21)(22)(23). That is the reason we decided to proceed to PRF of the occipital nerves for a more sustained result.…”

Section: Discussionmentioning

confidence: 99%

Pulsed Radiofrequency of the Occipital Nerves: Results of a Standardized Protocol on Chronic Headache Management

et al. 2021

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Background: Pulsed radiofrequency (PRF) of the occipital nerves has neuromodulative properties and is used for chronic pain management. However, its role in various types of chronic headaches has not been adequately investigated so far. Objectives: Τhis was an observational, open-label, prospective study aiming to assess the efficacy of PRF of occipital nerves on various types of chronic headache management. Methods: Patients with chronic headaches followed up at the pain management unit were scheduled for PRF of both occipital nerves after a positive diagnostic nerve block. PRF was applied following a standardized protocol at 42°C, and the number of headaches per month was assessed as a primary outcome at baseline (before treatment), as well as after 1, 3, and 6 months. Pain intensity during headache crises was recorded using the Numeric Rating Scale (NRS, 0 - 10), Results: Fifty-seven patients suffering from chronic migraines, cluster headaches, tension-type headaches, and occipital neuralgia were studied. PRF significantly improved the number of headache episodes per month, as well as the pain intensity of the crises. The median number of headache episodes per month was significantly reduced in patients with migraine, from 14.5 to 4 after 1 month, and to 6.5 after 6 months. The same was seen for patients with clusters, who were also improved. A statistically significant reduction in NRS values over time was seen for all types of headaches. Conclusions: PRF of the occipital nerves can lead to a reduction of the number of headache episodes per month, improving the intensity of pain during each episode.

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“…A variety of studies suggest that GON injections represent a safe and useful therapy in CH (see Table 4) [2,5,6,[11][12][13][14][15][16][17][18]. In spite of this, data from literature are not easily comparable due to the differences in inclusion criteria, protocol of treatment, type and doses of steroid and/ or anesthetics used and clinical outcome observed.…”

Section: Discussionmentioning

confidence: 99%

Great occipital nerve long-acting steroid injections in cluster headache therapy: an observational prospective study

et al. 2021

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Background Injections targeting the occipital nerve are used to reduce headache attacks and abort cluster bouts in cluster headache patients. There is no widely accepted agreement over the optimal technique of injection, type and doses of steroids and/or anesthetics to use, as well as injection regimens. The aim of this study was to verify the effectiveness and safety of greater occipital nerve long-acting steroid injections in the management of episodic and chronic cluster headache. Methods We conducted a prospective observational cohort study on episodic (ECH) and chronic cluster headache patients (CCH). ECH were included in the study at the beginning of a cluster period. Three injections with 60 mg methylprednisolone were performed on alternate days. We registered the frequency and intensity of attacks three days before and 3, 7 and 30 days after the treatment, the latency of cluster relapse, adverse events, scores evaluating anxiety (Zung scale), depression (Beck’s Depression Scale) and quality of life (Disability Assessment Schedule II, 12-Item Self-Administered Version). Primary outcome was the interruption of the cluster after the three injections. Responders conducted a follow-up period of 12 months. Results We enrolled 60 patients, 47 with ECH and 13 with CCH. We observed a complete response in 47.8% (22/46) of episodic and 33.3% (4/12) of chronic patients. Moreover, a partial response (reduction of at least 50% of attacks) was obtained in further 10.8% (5/46) of episodic and in 33.3% (4/12) of chronic patients at 1 month. Median pain-free period was of 3 months for CCH responders. Only mild adverse events were reported in 38.3% (23/58) cases. Conclusions We suggest three greater occipital nerve injections of 60 mg methylprednisolone on alternate days as useful therapy in episodic and chronic cluster headache. This leads to a long pain-free period in chronic forms. Adverse effects are mild and support its use as first choice. Trial registration The study was inserted in AIFA observational studies register.

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Suboccipital steroid injection alone as a preventive treatment for cluster headache

Cited by 12 publications

References 26 publications

Repeated greater occipital nerve injections with corticosteroids in medically intractable chronic cluster headache: a retrospective study

Repeated greater occipital nerve injections with corticosteroids in medically intractable chronic cluster headache: a retrospective study

Pulsed Radiofrequency of the Occipital Nerves: Results of a Standardized Protocol on Chronic Headache Management

Great occipital nerve long-acting steroid injections in cluster headache therapy: an observational prospective study

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