Occipital Nerve Injections and Ablation (Including Occipital Neuralgia and Headache)

A systematic review and meta-analysis were conducted by Shauly et al. (2019) to determine the efficacy of greater occipital nerve block in the treatment of chronic migraine headaches. Nine studies were analyzed that reported mean number of headache days per month in both intervention and control groups. The study included 440 participants (intervention, n = 224; control, n = 216). Six of the included randomized controlled trials reported intervention treatment as either bupivacaine or lidocaine versus saline injection. Three of the included randomized controlled trials reported intervention treatment as corticosteroid in addition to bupivacaine or lidocaine versus bupivacaine or lidocaine with saline as the control group. Eight of the studies that were analyzed reported the mean headache days per month in both intervention and control groups. A total of 417 patients were studied, with a pooled mean difference of −3.6 headache days (95 percent CI, −1.39 to −5.81 headache days; p < 0.00001). Pooled mean difference in pain scores of -2.2 (95 percent CI, -1.56 to -2.84) also demonstrated a decrease in headache severity compared with controls (p < 0.0121). Seven of the studies assessed reported mean visual analogue scale pain scores. Pooled mean difference in pain scores of −2.2 (95 percent CI, −1.56 to −2.84; p = 0.0121). Two studies also reported patients that experienced a greater than 50 percent reduction in headache frequency. Risk ratios were calculated in these two studies, and the average risk ratio was found to be 0.76 (95 percent CI, 0.97 to 0.55; p < 0.00001). The authors concluded that greater occipital nerve blocking should be recommended 51 patients with episodic and chronic CH that underwent greater occipital nerve (GON) blockade with a single dose of rapid and long-acting steroid injection without additional prophylactic treatment. Pain assessment was performed using the Visual Analog Scale (VAS). The patients were asked to keep a record of the frequency, severity, and duration of attacks after GON blockade. In 28 (54.9%) patients, no attack occurred after GON blockade and cluster bouts were halted. Mean duration of attacks was 86.67 ± 37.45 min before the treatment. In the 23 patients that had at least one attack after GON blockade, the mean duration of attacks was 31.73 ± 36.10 min between post-treatment days 0-3, 29.35 ± 40.49 min between post-treatment days 4-10, 28.48 ± 42.17 min between post-treatment days 11-28, and 35.65 ± 46.55 min after the post-treatment day 28 (p < 0.001). Between post-treatment days 0–3, the VAS score was 0 in 70.6% (n = 36), between 1 and 5 in 13.7% (n = 7), and between 6 and 10 in 15.7% (n = 8) of the patients. Between post-treatment days 4–10, the VAS score was 0 in 76.5% (n = 39), between 1 and 5 in 7.8% (n = 4), and between 6 and 10 in 15.7% (n = 8) of the patients. Between post-treatment days 11–28, the VAS score was 0 in 80.4% (n = 41), between 1 and 5 in 3.9% (n = 2), and between 6 and 10 in 15.7% (n = 8) of the patients. After the post-treatment day 28, the VAS score was 0 in 86.3% (n = 44) and between 6 and 10 in 13.7% (n = 7) of the patients. The authors concluded that GON blockade is a practical, reliable, and cost-effective treatment option for patients with episodic and chronic CH. The study is limited by its retrospective observations and small sample size. (IV) treatment metoclopramide). at 30, and 45 minutes a pain in the 5-, 15-, 30-, and 45-minutes PSS scores in the GON blockade group in the dexketoprofen and placebo groups. a GON blockade effective as an IV dexketoprofen metoclopramide treatment to a placebo in patients with acute migraine headaches. No follow-up heterogeneous A systematic review conducted to evaluate the clinical efficacy and safety of occipital nerve stimulation (ONS) for treating migraine. Five randomized controlled trials, 4 retrospective studies, and one prospective study met the inclusion criteria. The authors concluded that results from the retrospective studies and case series indicated that ONS significantly reduced the pain intensity and the number of days with headache in patients with migraine. The evidence of ONS efficacy established by randomized controlled trials was limited. Improvement was noted in the migraine disability assessment (MIDAS) score and SF-36 score at follow-up. The mean complication incidence of ONS was 66% for the reviewed studies. The authors recommended that future clinical studies should optimize and standardize the ONS intervention process and identify the relationship among the surgical process, efficacy, and complications resulting from the procedure. et evaluated six months of results from repeated greater occipital nerve blocks (GON). A standard 2 mL of 0.5% Bupivacaine GON blockage once a week for 4 weeks was applied. The Visual Analog Scale (VAS) scores, the number of migraine attacks and the Migraine Disability Assessment Questionnaire (MIDAS) scores were reported. The patients were not allowed to use medication for prophylaxis, and Ibuprofen was prescribed for any migraine attacks. The initial mean number of attacks per month before starting treatment was 8.33+2.31. After treatment, the initial MIDAS mean was found to be 2.82 per month; this declined to 1.47 in 3rd and was 1.50 in the 6th month. The mean VAS scores were recorded management of cervicogenic headache (CHA). The review included relevant literature identified through searches of PubMed, Cochrane, Clinical trials, U.S. National Guideline Clearinghouse and EMBASE from 1960 to January 2014. The focus was on randomized trials and case-control, prospective, cohort, and cross-sectional studies with participants suffering from CHA who had failed conservative management. A study was judged to be positive if the interventions provided headache relief and improved quality of life. There were 5 non-randomized trials among them 4/5 were of moderate quality, 3/5 showed RF ablation and 1/5 showed PRF as an effective intervention for cervicogenic headache. There were 4 randomized trials among them 2/4 were of high quality, 3/4 investigated RF ablation as an intervention for CHA, and 1/4 investigated PRF ablation as an intervention for CHA. None of the randomized studies showed strong evidence for RF and PRF ablation as an effective intervention for CHA. There were 2 RCTs which did not show significant benefits with RFA. There is limited evidence for RF and pulsed RFA therapies for management of CHA. Evidence is insufficient to assess the effects on the health outcomes because of the limited number of studies or the low power of the studies, unexplained inconsistency between RCTs, flaws in trial design, gaps in the chain of evidence, and lack of detailed information on desired health outcomes. effectiveness and of transcutaneous electrical nerve (TENS) on with migraine. four randomized controlled trials, compared the effect of TENS (n = 161) with sham TENS (n = 115). in the number of monthly headache days, responder rate, painkiller intake, adverse events and satisfaction were extracted as outcome. authors concluded that there is low quality evidence suggesting that TENS may be effective in increasing responder rate, reducing headache days and painkiller intake, serving as a well-tolerated alternative for migraineurs. Future well-designed RCTs with extensive follow-up are needed. An uncontrolled open-label prospective study conducted Thirty-one patients with intractable short-lasting unilateral neuralgiform headache attacks were treated with bilateral occipital nerve stimulation. At a mean follow-up of 44.9 months (range 13-89) there was a 69% improvement in attack frequency with a response rate (defined as at least a 50% improvement in daily attack frequency) of 77%. Attack severity reduced by 4.7 points on the verbal rating scale and attack duration by a mean of 64%. Improvements were seen in headache-related disability and depression. Adverse event rates were favorable, with no electrode migration or erosion reported. The authors concluded that occipital nerve stimulation appears to offer a safe and efficacious treatment for refractory short-lasting unilateral neuralgiform headache attacks. This is an uncontrolled study with a small sample size.