The Effects of Repetitive Greater Occipital Nerve Blocks on Cervicogenic Headache
Devrimsel Harika Ertem1
, İlhan Yılmaz2
1University of Health Sciences, Istanbul Sisli Hamidiye Etfal Training and Research Hospital, Clinic of Algology, Istanbul, Turkey
2University of Health Sciences, Istanbul Sisli Hamidiye Etfal Training and Research Hospital, Clinic of Neurosurgery, Istanbul, Turkey
Keywords: Headache, cervicogenic headache, chronic pain, greater occipital nerve, nerve block
Abstract
Objective: The clinical features of cervicogenic headache (CH) are characterized by unilateral, dull headache; precipitated by neck movements or external pressure over the great occipital nerve (GON). No conservative therapies have been proved to be effective for the management of CH. The purpose of this study was to assess the effects of interventional pain management, including repetitive anesthetic block using lidocaine and methylprednisolone GON injections for local pain and associated headache.
Materials and Methods: This retrospective cohort study was undertaken between January 2016 and December 2017. Twenty-one patients with CH were evaluated in our headache clinic during the study period. The diagnosis of CH was made according to International Classification of Headache Disorders 3rd edition beta version. The socio-demographic and clinical characteristics were recorded for all patients who underwent at least 3 GON blocks and attended at least 4 follow-up appointments. Change in the Numeric Pain Rating Scale (NPRS) was used to assess the response to GON blocks. SPSS 23.0 was used as the statistical analysis program.
Results: The mean age of patients was 61.51±13.88 years; 42.85% were female. The duration of headache was 30.81±21.95 years. Eighty-five percent of patients had unilateral headache. Ten patients had myofascial spasm (trigger points) located in neck, occipitalis, and temporalis muscles. Sixty-six percent of patients reported headache following head trauma. From 3-months post treatment, a significant decrease in NPRS (p<0.001) was identified. The number of headaches was reduced significantly at three months (p<0.001) No serious complications were noted. The coexistence of myofascial spasms, history of trauma and additional headache had no significant effect on NPRS score improvements (p>0.05).
Conclusion: The results of this study demonstrated that repetitive greater occipital blocks may be an effective option for the management of CH and contribute to significant reductions in pain severity scores at 3 months following injection.