Comparison of Occipital Nerve and Sphenopalatine Ganglion Blockade
Condition: Migraine
MeSH terms: Migraine Disorders
Study type: Interventional

Summary: 
      Migraine is a chronic disorder that causes disability. Episodic migraine can be managed by
      prophylactic medical treatment or interventional pain procedures. Interventional methods used
      in migraine treatment are greater occipital nerve blockade, lesser occipital nerve blockade,
      supraorbital nerve blockade, infraorbital nerve blockade, sphenopalatine ganglion blockade,
      botulinum toxin injection and various radiofrequency applications. The effectiveness of
      greater occipital nerve blockade and transnasal sphenopalatine ganglion blockade in the
      treatment of migraine has been proven in various studies.We aimed to evaluate the effects of
      repetitive greater occipital nerve blockade and transnasal sphenopalatine ganglion blockade
      in patients with episodic migraine.
    

Detailed description: 
      Migraine is a common primary headache and causes a significant personal, social and financial
      burden. Migraine is characterized by a semi-headache lasting 4-72 hours, accompanied by
      nausea/vomiting and photophobia/phonophobia. Migraine can be episodic or chronic.
      Non-steroidal anti-inflammatory drugs, triptan and ergotamine derivatives can be used in the
      treatment of acute migraine attacks. Beta-blockers, calcium channel blockers, antiepileptic
      drugs and antidepressant drugs are among the prophylactic medical treatments. When medical
      treatment cannot provide adequate pain palliation, in case of side effects or when the
      patient does not prefer medical treatment, interventional methods come to the fore.
      Interventional methods that applied in migraine treatment are greater occipital nerve
      blockade, lesser occipital nerve blockade, supraorbital nerve blockade, infraorbital nerve
      blockade, sphenopalatine ganglion blockade, botulinum toxin injection and various
      radiofrequency applications. The effectiveness of greater occipital nerve blockade and
      transnasal sphenopalatine ganglion blockade in the treatment of migraine has been proven in
      various studies.

      It is stated that sphenopalatine ganglion blockade reduces the number of headache days and is
      effective in the treatment of acute migraine attacks. Although there are studies on the
      effectiveness of greater occipital nerve blockade and transnasal sphenopalatine ganglion
      blockade in migraine treatment, there are no studies comparing their superiority over each
      other. This study aims to evaluate the effects of repetitive greater occipital nerve blockade
      and transnasal sphenopalatine ganglion blockade on headache severity, number of days with
      headache, headache duration, functionality and medication use in patients with episodic
      migraine, and to compare whether they are superior to each other.

      In this single center randomised study participants' episodic migraine will be diagnosed
      according to the International Classification of Headache Disorders 3rd version (ICHD-3)
      criteria. Demographic information of the patients, including age, gender, comorbidities,
      educational status, marital status and migraine duration, will be recorded. Pain intensity of
      patients will be evaluated using the Numeric Rating Scala (NRS 11) scale, and functionality
      will be evaluated using MIDAS. Before the procedure, the number of headache days in a 1-month
      period, headache severity, duration, amount of medication use (non-steroidal
      anti-inflammatory analgesic, triptan) and MIDAS score will be recorded. Participants will be
      randomized into 2 groups. When 21 participants are randomized in each group, participant 26
      will be excluded from the list because it is in both groups. Group 1 greater occipital nerve
      block; It will be applied for participants 37, 27, 35, 13, 36, 18, 34, 33, 6, 12, 3, 25, 19,
      1, 14, 9, 21, 38, 10, 2. Group 2 sphenopalatine block; It will be applied to patients 22, 1,
      24, 11, 35, 33, 17, 14, 8, 31, 39, 5, 2, 28, 41, 36, 15, 7, 34, 27. Greater occipital nerve
      block will be applied to participant number 26 by repeating the procedure order since the
      number of participants in each group is equally divided.

      Participants will receive greater occipital nerve blockade and transnasal sphenopalatine
      ganglion blockade once a week for the first month and then once a week for a further 1 month.
      At the 1st month, 2nd month and 3rd month follow-up visits of the participants, the number of
      headache days, average pain intensity and pain duration, MIDAS scores and the amount of
      medication used (non-steroidal anti-inflammatory analgesic, triptan) will be recorded with
      pain diaries. Participants' pain diaries, MIDAS scores and the amount of medication they use
      will be recorded. Additionally, possible complications in patients will also be recorded.
    

Intervention name(s): greater occipital nerve block; transnasal sphenopalatine ganglion block
Intervention type(s): Procedure; Procedure
Intervention description(s): greater occipital nerve block; transnasal sphenopalatine ganglion block
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: pain; migraine; nerve block