American Society for Peripheral Nerve

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Greater Occipital Nerve Block For The Treatment Of Chronic Migraine Headaches: A Systematic Review And Meta-Analysis
Orr D. Shauly, MS; Daniel Joseph Gould, MD PhD; Ketan M. Patel, MD
Division of Plastic and Reconstructive Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA

Background: Few treatment options exist for chronic migraine headaches, with peripheral nerve blocks having long been used to reduce frequency and severity of migraines. Although the therapeutic effects have been observed in clinical practice, the efficacy has never been fully studied. In the past decade however, several randomized clinical controlled trials have been conducted to assess the efficacy of greater occipital nerve (GON) block in the treatment of chronic migraine headaches. The goal of this study was to analyze the currently available data and establish clinical guidelines for the use of GON block in the treatment of chronic migraines.

Methods: A systematic review of the literature was performed in the citation databases PubMed, Embase, Medline and The Cochrane Library. The initial search of databases yielded 259 citations of which 33 were selected as candidates for full-text review. Of these, 9 studies were selected for inclusion in this meta-analysis.

Results: Studies were analyzed that reported mean headache days per month in both intervention and control groups. A total of 417 patients were studied, with a pooled mean difference of -3.60 headache days (95% CI = -1.39 to -5.81). This demonstrates that GON block intervention significantly reduced the frequency of migraine headaches compared to control (p < 0.00001). Secondary analysis was also performed on mean visual analog scale (VAS) pain scores of study participants. Pooled mean difference in VAS pain scores of -2.20 (95% CI = -1.56 to -2.84) demonstrated significant decrease in headache severity compared to control (p = 0.0121). Two studies also reported patients that experienced a greater than 50% reduction in headache frequency. Risk ratios were calculated in these two studies, and the average risk ratio was found to be 0.76 (95% CI = 0.97 to 0.55). This demonstrated a significant decrease in headache frequency (p < 0.00001).

Conclusion: GON block should be recommended for use in migraine patients, in particular those that may require future surgical intervention. GON block may act as an important stepping stone for patients experiencing migraine headache, in its ability to potentially assess surgical candidates for nerve decompression.

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