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Greater occipital nerve blocks effectively treat migraines
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Most patients with migraine who underwent a greater occipital nerve block for treatment reported moderate to significant positive responses, according to findings recently published in the Journal of the American Board of Family Medicine.
“No current guidelines include [greater occipital nerve] block in the management of migraine headache although many studies have researched this, with variable results and conclusions,” Sorcha M. Allen, MB, BCh, BAO, of the department of internal medicine at the Mayo Clinic in Phoenix and colleagues wrote.
Researchers retrospectively analyzed changes in the 11-point numeric pain rating scale of 562 patients (mean age, 58.6 years) who had at least one greater occipital nerve block and one appointment after the procedure. Of the participants, 75% were women.
Allen and colleagues found that 82% of patients reported a moderate response — between 31% and 50% change in points — or significant — greater than 50% change in points. These findings were regardless of number of greater occipital nerve blocks performed, which specialty performed the treatment, age, sex, or previous treatments.
In addition, a significant link was discovered between patients who received two or more greater occipital nerve blocks and lower pain scores (P < .001), according to researchers. The number needed to treat in patients who underwent one or greater occipital nerve block vs. those who underwent two or more such treatments was 2.6.
“Overall, our findings are very positive in terms of the efficacy of [greater occipital nerve] block as a treatment option for migraine headache,” Allen and colleagues wrote. “Large placebo-controlled clinical trials are needed to confirm our findings, along with those from several smaller observational studies and randomized trials. Further data would help to solidify the use of [greater occipital nerve] block in the treatment of migraine headache and potentially assist with its inclusion within future treatment guidelines.” – by Janel Miller
Disclosure: Allen reports no relevant financial disclosures. Please see the study for the other authors’ relevant financial disclosures.
Perspective
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Stephen Silberstein, MD
While people have been doing greater occipital nerve blocks for a long time to quickly and rapidly treat migraines, there are certain things that must be considered. One: does it work; two: how long does the treatment last; and three: will greater occipital nerve blocks be covered by insurance?
Regarding those first two points, we and others have done studies, some of which are cited by Allen and colleagues, that show the addition of steroids to a greater occipital nerve block makes no difference in migraine treatment. We often combine greater occipital nerve blocks with trigger point injections. Our results mirror those presented in this new study performed by Allen and colleagues. So, from my experience, if you have a patient with an acute migraine headache, give them a greater occipital nerve block to create immediate relief and sometimes that relief can be sustained.
The fundamental issue here is how difficult it is to get insurance companies to approve greater occipital nerve block treatments. If you have a patient come in regularly for such treatments, these can usually be approved, but if a patient shows up in the ED or in the office with a bad headache, the treatment may not get the insurance company’s immediate approval, prolonging the patient’s pain and suffering. Perhaps there should be a change to the paradigm so that even those who don’t get prior approval for greater occipital nerve blocks can still have them covered in emergency situations.
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