Effects of cranial nerve blockage in patients with chronic migraine resistant to first-line treatment
Keywords:Chronic migraine, Nerve block, Great occipital nerve, GON, SON
Background/Aim: Migraine is a common, disabling neurological disorder and cranial nerve blocks (CNB) are used in the treatment of headaches. This study aimed to compare the effectiveness of a CNB with conventional medical treatment in patients with chronic migraine resistant to first-line treatment. Methods: This retrospective cohort study included 102 patients with chronic migraine resistant to first-line treatment who were treated in our outpatient clinic. The patients were divided into two groups as those who underwent CNB (n=67) and the control group, who were only treated with conventional drugs (n=35). Bilateral CNB was performed on the patients at baseline and in the second week. The patients’ Visual Analogue Scale (VAS) scores, number of days in pain, and the number of analgesics taken were recorded at baseline and the second month. Results: The second-month VAS scores and the number of days in pain were significantly lower than baseline in both the CNB and control groups (P<0.01, and P<0.05, respectively). However, while the number of analgesics taken in the 2nd month was lower in the CNB group, it was similar in the control group. (P<0.01, P=0.33). No significant difference was found between the groups in terms of the number of days in pain in the second month (P=0.09). The second month's VAS scores and the number of analgesics taken were significantly lower in the CNB group compared to the control group (P=0.01, P<0.01). Conclusion: Our findings indicated that the CNB was more effective than conventional treatment in patients with chronic migraine resistant to first-line treatment.
Stewart WF, Shechter A, Rasmussen B. Migraine prevalence. A review of population-based studies. Neurology. 1994;44(6 Suppl 4):S17-23.
Ertas M, Baykan B, Orhan EK, Zarifoglu M, Karli N, Saip S, et al. One-year prevalence and the impact of migraine and tension-type headache in Turkey: a nationwide home-based study in adults. J Headache Pain. 2012;13(2):147-57. doi: 10.1007/s10194-011-0414-5
Ha H, Gonzalez A. Migraine Headache Prophylaxis. American family physician. 2019;99(1):17-24.
Blumenfeld AM, Bloudek LM, Becker WJ, Buse DC, Varon SF, Maglinte GA, et al. Patterns of use and reasons for discontinuation of prophylactic medications for episodic migraine and chronic migraine: Results from the second International Burden of Migraine Study (IBMS‐II). Headache: The Journal of Head and Face Pain. 2013;53(4):644-55. doi: 10.1111/head.12055
Blumenfeld A, Ashkenazi A, Napchan U, Bender SD, Klein BC, Berliner R, et al. Expert Consensus Recommendations for the Performance of Peripheral Nerve Blocks for Headaches – A Narrative Review. Headache: The Journal of Head and Face Pain. 2013;53(3):437-46. doi: 10.1111/head.12053
Terzi T, Karakurum B, Üçler S, İnan LE, Tulunay C. Greater occipital nerve blockade in migraine, tension-type headache and cervicogenic headache. J Headache Pain. 2002;3(3):137-41. doi: 10.1007/s101940200031
Ashkenazi A, Young WB. The Effects of Greater Occipital Nerve Block and Trigger Point Injection on Brush Allodynia and Pain in Migraine. Headache: The Journal of Head and Face Pain. 2005;45(4):350-4. doi: 10.1111/j.1526-4610.2005.05073.x
Inan N, Inan LE, Coşkun Ö, Tunç T, Ilhan M. Effectiveness of Greater Occipital Nerve Blocks in Migraine Prophylaxis. Noro Psikiyatr Ars. 2016;53(1):45-8. doi: 10.5152/npa.2015.10003
Tang Y, Kang J, Zhang Y, Zhang X. Influence of greater occipital nerve block on pain severity in migraine patients: A systematic review and meta-analysis. The American Journal of Emergency Medicine. 2017;35(11):1750-4. doi: 10.1016/j.ajem.2017.08.027
Zhang H, Yang X, Lin Y, Chen L, Ye H. The efficacy of greater occipital nerve block for the treatment of migraine: A systematic review and meta-analysis. Clinical Neurology and Neurosurgery. 2018;165:129-33. doi: 10.1016/j.clineuro.2017.12.026
Caputi CA, Firetto V. Therapeutic Blockade of Greater Occipital and Supraorbital Nerves in Migraine Patients. Headache: The Journal of Head and Face Pain. 1997;37(3):174-9. doi: 10.1046/j.1526-4610.1997.3703174.x
Gul HL, Ozon AO, Karadas O, Koc G, Inan LE. The efficacy of greater occipital nerve blockade in chronic migraine: A placebo-controlled study. Acta Neurologica Scandinavica. 2017;136(2):138-44. doi: 10.1111/ane.12716
Inan LE, Inan N, Karadaş Ö, Gül HL, Erdemoğlu AK, Türkel Y, et al. Greater occipital nerve blockade for the treatment of chronic migraine: a randomized, multicenter, double-blind, and placebo-controlled study. Acta Neurologica Scandinavica. 2015;132(4):270-7. doi: 10.1111/ane.12393
Okmen K, Dagistan Y, Dagistan E, Kaplan N, Cancan E. Efficacy of the greater occipital nerve block in recurrent migraine type headaches. Neurologia i Neurochirurgia Polska. 2016;50(3):151-4. doi: 10.1016/j.pjnns.2016.01.015
Ashkenazi A, Matro R, Shaw JW, Abbas MA, Silberstein SD. Greater occipital nerve block using local anaesthetics alone or with triamcinolone for transformed migraine: a randomised comparative study. Journal of Neurology, Neurosurgery & Psychiatry. 2008;79(4):415. doi: 10.1136/jnnp.2007.124420
Tobin J, Flitman S. Treatment of migraine with occipital nerve blocks using only corticosteroids. Headache. 2011;51(1):155-9. doi: 10.1111/j.1526-4610.2010.01801.x
Ünal-Artık HA, İnan LE, Ataç-Uçar C, Yoldaş TK. Do bilateral and unilateral greater occipital nerve block effectiveness differ in chronic migraine patients? Neurological Sciences. 2017;38(6):949-54. doi: 10.1007/s10072-017-2861-5
Deniz Palamar M, Derya Uluduz M, Sabahattin Saip M, Gul Erden M. Ultrasound-guided greater occipital nerve block: an efficient technique in chronic refractory migraine without aura? Pain Physician. 2015;18:153-62. doi: 10.36076/ppj/2015.18.153
Kashipazha D, Nakhostin-Mortazavi A, Mohammadianinejad SE, Bahadoram M, Zandifar S, Tarahomi S. Preventive effect of greater occipital nerve block on severity and frequency of migraine headache. Global journal of health science. 2014;6(6):209. doi: 10.5539/gjhs.v6n6p209
Dilli E, Halker R, Vargas B, Hentz J, Radam T, Rogers R, et al. Occipital nerve block for the short-term preventive treatment of migraine: A randomized, double-blinded, placebo-controlled study. Cephalalgia. 2014;35(11):959-68. doi: 10.1177/0333102414561872
Takmaz SA, İnan N, Uçler S, Yazar MA, İnan L, Başar H. Greater occipital nerve block in migraine headache: preliminary results of 10 patients. The journal of the Turkish Society of Algology. 2008;20(1):47-50.
Piñero MR, Carrillo PM, Hueso MP, de la Cruz Rodríguez C, Mesonero LL, Peral AG. Pericranial nerve blockade as a preventive treatment for migraine: experience in 60 patients. Neurología (English Edition). 2016;31(7):445-51. doi: 10.1016/j.nrl.2014.10.001
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