Greater occipital nerve injection in primary headache syndromes – Prolonged effects from a single injection

Headache Group, Institute of Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
Pain (Impact Factor: 5.21). 06/2006; 122(1-2):126-9. DOI: 10.1016/j.pain.2006.01.016
Source: PubMed


Most patients with primary headache syndromes who have frequent attacks of pain have tenderness in the sub-occipital region. Injection of the greater occipital nerve (GON) with local anesthetic and corticosteroids has been widely used in clinical practice for many years, yet there is no clear understanding of its mechanisms of action. Moreover, there is no current gold-standard of practice regarding GON injections in the management of headache. We audited of our practice to generate hypotheses about the range of primary headaches that might benefit, to determine response rates to power future studies, and to assess whether we should continue to do this procedure. Twenty-six of fifty-seven injections in 54 migraineurs yielded a complete or partial response that lasted for the partial response a median of 30 days. For cluster headache 13 of 22 injections yielded a complete or partial response lasting for a median of 21 days for the partial response. Tenderness over the GON was strongly predictive of outcome, although local anesthesia after the injection was not. The presence or absence of medication overuse did not predict outcome. Apart from two patients with a small patch of alopecia the injection was well tolerated. GON injection is a useful tool in some patients that provides interim relief while other approaches are explored. It is remarkable that in all conditions in which an effect is observed the response time so much exceeds the local anesthetic effect that the mechanism of action may well be through changes in brain nociceptive pathways.

    • "We are aware that local anesthetic may in some cases provide a long-lasting effect, possibly by reversing or slowing peripheral or even central sensitization [1] [33]. Consequently, the sham injection group may have experienced some pain relief beyond the short pharmacological effect of lidocaine. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Adhesive capsulitis (frozen shoulder) is a common cause of shoulder pain and disability. Previous studies have reported that intra-articular corticosteroid injections are of benefit compared with placebo up to six weeks. It has been suggested that the structures primarily involved in adhesive capsulitis are the capsule and the rotator interval. Systematic reviews have concluded that there is limited evidence of the treatment effectiveness of intra-articular corticosteroid injections and that high quality primary research is required. The aim of this study was to compare ultrasound guided intra-articular corticosteroid injection and combined intra-articular and rotator interval injection in a double blind, sham controlled randomized clinical trial. The main outcome measure was the group difference in change in shoulder pain (0-10) at six weeks. One hundred and twenty-two patients were randomized (42 to intra-articular injection, 40 to combined intra-articular/interval injection, 40 to sham injection). For both corticosteroid injection groups there was a significant difference compared to sham injection at week 6. The mean group difference (adjusted for gender, age, dominant arm and duration) in change in shoulder pain for intra-articular versus sham injection was -1.7 (95% confidence interval -2.7 to -0.6, p=0.002) and -2.1 (95% CI -3.2 to -1.1, p=0.0001) for the combined injection versus sham injection. The significant group differences were maintained at week 12 but not at week 26. Similar results were found for the secondary outcome measures (night pain, shoulder pain and disability index). Differences between the corticosteroid groups were not significant at any time.
    No preview · Article · Apr 2015 · Pain
  • Source
    • "In cases of continual pain, nerve blocks may be applied or invasive procedures such as occipital nerve stimulation, neurolysis of the occipital nerves, or dorsal root entry zone rhizotomy may be performed20,21). However, the effects of nerve blocks are temporary, and surgical treatments are invasive and have risk and complications1,13,23). In this study, we present the clinical outcome of 10 patients with ON treated by pulsed radiofrequency (PRF). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Occipital neuralgia is characterized by paroxysmal jabbing pain in the dermatomes of the greater or lesser occipital nerves caused by irritation of these nerves. Although several therapies have been reported, they have only temporary therapeutic effects. We report the results of pulsed radiofrequency treatment of the occipital nerve, which was used to treat occipital neuralgia. Patients were diagnosed with occipital neuralgia according to the International Classification of Headache Disorders classification criteria. We performed pulsed radiofrequency neuromodulation when patients presented with clinical findings suggestive occipital neuralgia with positive diagnostic block of the occipital nerves with local anesthetics. Patients were analyzed according to age, duration of symptoms, surgical results, complications and recurrence. Pain was measured every month after the procedure using the visual analog and total pain indexes. From 2010, ten patients were included in the study. The mean age was 52 years (34-70 years). The mean follow-up period was 7.5 months (6-10 months). Mean Visual Analog Scale and mean total pain index scores declined by 6.1 units and 192.1 units, respectively, during the follow-up period. No complications were reported. Pulsed radiofrequency neuromodulation of the occipital nerve is an effective treatment for occipital neuralgia. Further controlled prospective studies are necessary to evaluate the exact effects and long-term outcomes of this treatment method.
    Full-text · Article · May 2012 · Journal of Korean Neurosurgical Society
  • Source
    • "Our data do at present not support a predictive role of hypoesthesia for ONB efficacy. This is in line with a previous study on cluster headache, migraine and new daily persistent headache [9] which found no significant association between occipital hypoesthesia and ONB efficacy. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Occipital nerve block (ONB) has been used in several primary headache syndromes with good results. Information on its effects in facial pain is sparse. In this chart review, the efficacy of ONB using lidocaine and dexamethasone was evaluated in 20 patients with craniofacial pain syndromes comprising 8 patients with trigeminal neuralgia, 6 with trigeminal neuropathic pain, 5 with persistent idiopathic facial pain and 1 with occipital neuralgia. Response was defined as an at least 50% reduction of original pain. Mean response rate was 55% with greatest efficacy in trigeminal (75%) and occipital neuralgia (100%) and less efficacy in trigeminal neuropathic pain (50%) and persistent idiopathic facial pain (20%). The effects lasted for an average of 27 days with sustained benefits for 69, 77 and 107 days in three patients. Side effects were reported in 50%, albeit transient and mild in nature. ONBs are effective in trigeminal pain involving the second and third branch and seem to be most effective in craniofacial neuralgias. They should be considered in facial pain before more invasive approaches, such as thermocoagulation or vascular decompression, are performed, given that side effects are mild and the procedure is minimally invasive.
    Full-text · Article · Mar 2012 · The Journal of Headache and Pain
Show more