Effectiveness of greater occipital nerve blocks in chronic migraine



Chronic migraine, Greater occipital nerve block, Headache attack frequency, Headache severity


Background/Aim: Chronic migraine (CM) is defined as headache occurring on 15 or more days per month for more than three months, which, on at least 8 days per month, has the features of a migraine headache. Greater occipital nerve (GON) blocks with local anesthetics and steroids are used in CM. GON block is widely used effectively in CM treatment. The aim of this study was to assess the effectiveness of GON blocks in CM. Methods: This retrospective cohort study was conducted in Bulent Ecevit University Faculty of Medicine, Department of Neurology. Data of 43 CM patients who had GON block were collected. CM was diagnosed using International Classification of Headache Disorders (ICHD-3). GON blocks were repeated every week in the first month and monthly thereafter for the following 6 months. The injections were performed radially at 2 cm lateral and 2 cm inferior to the protuberantia occipitalis externa with a needle and 2 mL of 0.25% bupivacaine bilaterally. Headache attack frequency (days), headache duration (hours) and severity of pain (Visual Analog Scale (VAS)) were compared between before and after GON block in the first month. Results: Headache attack frequency decreased from 12.8 (8.4) (pretreatment) to 3.8 (3.5), and headache severity (VAS), from 8.5 (1.2) to 4.5 (1.8) (P<0.001 for both) within one month. No serious adverse effects were observed. Conclusion: This study showed significant decreases in headache parameters in CM. GON block is widely used effectively in CM treatment, and there is a need to standardize the application technique, dose, and frequency.


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Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia. 2013;33:629–808.

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 Neurol Scand. 2017;136(2):138-44. doi: 10.1111/ane.12716

May A, Schulte LH. Chronic migraine: risk factors, mechanisms and treatment. Nat Rev Neurol. 2016;12(8):455-64. doi:10.1038/nrneurol.2016.93

Buse DC, Manack AN, Fanning KM, Serrano D, Reed ML, Turkel CC, et al. Chronic migraine prevalence, disability, and sociodemographic factors: results from the American Migraine Prevalence and Prevention Study. Headache. 2012;52(10):1456-70. doi: 10.1111/j.1526-4610.2012.02223.x

Unal-Artık HA, Inan LE, Atac-Ucar C, Yoldas TK. Do bilateral and unilateral greater occipital nerve block effectiveness differ in chronic migraine patients?. Neurol Sci. 2017;38(6):949-54. doi:10.1007/s10072-017-2861-5

Blumenfeld AM, Aurora SK, Laranjo K, Papapetropoulos S. Unmet clinical needs in chronic migraine: rationale for study and design of COMPEL, an open-label, multicenter study of the long-term efficacy, safety, and tolerability of onabotulinumtoxinA for headache prophylaxis in adults with chronic migraine. BMC Neurol. 2015;15:100. doi: 10.1186/s12883-015-0353-x

Sun-Edelstein C, Rapoport AM. Update on the pharmacological treatment of chronic migraine. Curr Pain Headache Rep. 2016;20(1):6. doi: 10.1007/s11916-015-0533-9

Allen SM, Mookadam F, Cha SS, Freeman JA, Starling AJ, Mookadam M. Greater occipital nerve block for acute treatment of migraine headache: a large retrospective cohort study. J Am Board Fam Med. 2018;31(2):211-8. doi: 10.3122/jabfm.2018.02.170188

Afridi SK, Shields KG, Bhola R, Goadsby PJ. Greater occipital nerve injection in primary headache syndromes–prolonged effects from a single injection. Pain. 2006;122(1–2):126–9. doi: 10.1016/j.pain.2006.01.016

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. J Neurol Neurosurg Psychiatry. 2008;79:415–7. doi: 10.1136/jnnp.2007.124420

Ashkenazi A, Blumenfeld A, Napchan U, et al. Peripheral nerve blocks and trigger point injections in headache management - a systematic review and suggestions for future research. Headache. 2010;50:943–52. doi: 10.1111/j.1526-4610.2010.01675.x

Ozer D, Boluk C, Turk Boru U, Altun D, Tasdemir M, Koseoglu Toksoy C. Greater occipital and supraorbital nerve blockade for the preventive treatment of migraine: a single-blind, randomized, placebo-controlled study. Curr Med Res Opin. 2019;35(5):909-15. doi: 10.1080/03007995.2018.1532403

Tobin JA, Fitman SS. Occipital nerve blocks: effect of symptomatic medication overuse and headache type on failure rate. Headache. 2009;49(10):1479–85. doi: 10.1111/j.1526-4610.2009.01549.x

Gawel MJ, Rothbart PJ. Occipital nerve block in the management of headache and cervical pain. Cephalalgia. 1992;12:9–13. doi: 10.1046/j.1468-2982.1992.1201009.x

Inan N, Ceyhan A, Inan L, Kavaklioğlu O, Alptekin A, Unal A. C2/C3 nerve blocks and greater occipital nerve block in cervicogenic headache treatment. Funct Neurol. 2001;16:239–43. PMID: 11769869

Karadas O, Gul HL, Inan LE. Lidocaine injection of pericranial myofascial trigger points in the treatment of frequent episodic tension‐type headache. J Headache Pain. 2013;14:44–51. doi: 10.1186/1129-2377-14-44

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. Clin Neurol Neurosurg. 2018;165:129-33. doi: 10.1016/j.clineuro.2017.12.026

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;3:137–41. doi: 10.1007/s101940200031

Inan LE, Inan N, Karadas O, Gul HL, Erdemoglu AK, Turkel Y, et al. Greater occipital nerve blockade for the treatment of chronic migraine: A randomized, multicenter, double‐blind, and placebo‐controlled study. Acta Neurol Scand. 2015;132(4):270-7. doi: 10.1111/ane.12393

Cuadrado, ML, Aledo-Serrano, Á, Navarro, P Short-term effects of greater occipital nerve blocks in chronic migraine: A double-blind, randomised, placebo-controlled clinical trial. Cephalalgia. 2017;37:864–72. doi: 10.1177/0333102416655159

Inan LE, Inan N, Unal-Artık HA, Atac C, Babaoglu G. Greater occipital nerve block in migraine prophylaxis: narrative review. Cephalalgia. 2019;39(7):908-20. doi: 10.1177/0333102418821669

Inan, N, Inan LE, Coskun O. Effectiveness of greater occipital nerve blocks in migraine prophylaxis. Arch Neuropsychiatr. 2016;53:45–8. doi: 10.5152/npa.2015.10003

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. 2015;35:959–68. doi: 10.1177/0333102414561872

Su M, Yu S. Chronic migraine: A process of dysmodulation and sensitization. Mol Pain 2018;14:1-10. doi:10.1177/1744806918767697

Okmen K, Dagistan Y, Dagistan E, Kaplan N, Cancan E. Efficacy of the greater occipital nerve block in recurrent migraine type headaches. Neurol Neurochir Pol. 2016;50:151–4. doi: 10.1016/j.pjnns.2016.01.015

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 2013;53(3): 437-446. doi: 10.1111/head.12053

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. Am J Emerg Med. 2017; 35(11):1750-4. doi: 10.1016/j.ajem.2017.08.027

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. Glob J Health Sci. 2014;6:209-13. doi: 10.5539/gjhs.v6n6p209






Research Article

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Aciman Demirel E, Karpuz B, Özdemir S, Kalaycı G, Atasoy HT. Effectiveness of greater occipital nerve blocks in chronic migraine. J Surg Med [Internet]. 2021 Jun. 1 [cited 2024 Jun. 19];5(6):593-6. Available from: https://jsurgmed.com/article/view/911665