Treatment of migraine with occipital nerve blocks using only corticosteroids.

Headache. 2011 Jan;51(1):155-9. 

doi: 10.1111/j.1526-4610.2010.01801.x. Epub 2010 Nov 10.

Tobin J, Flitman S.

From 21st Century Neurology, Phoenix, AZ, USA.

Abstract

(Headache 2011;51:155-162) The indications for using steroids when performing occipital nerve blocks (ONBs) are not completely clear. We report a patient with chronic migraines who was allergic to local anesthetics, for whom ONBs using only corticosteroid proved useful. To our knowledge, this is only published case describing the effects of ONBs using only corticosteroid, without local anesthetic.

© 2010 American Headache Society.

Treatment of Migraine With Occipital Nerve Blocks Using Only Corticosteroids

1. Headache: The Journal of Head and Face Pain

10 NOV 2010

1. Joshua Tobin MD, 
2. Stephen Flitman MD

DOI: 10.1111/j.1526-4610.2010.01801.x

The indications for using steroids when performing occipital nerve blocks (ONBs) are not completely clear. We report a patient with chronic migraines who was allergic to local anesthetics, for whom ONBs using only corticosteroid proved useful. To our knowledge, this is only published case describing the effects of ONBs using only corticosteroid, without local anesthetic.

Cervical Facet Arthropathy and Occipital Neuralgia: Headache Culprits

CURRENT PAIN AND HEADACHE REPORTS

Volume 14, Number 6, 418-423, DOI: 10.1007/s11916-010-0151-5

J. D. Hoppenfeld

Abstract

Cervicogenic headache (CH) is pain referred from the neck. Two common causes are cervical facet arthropathy and occipital neuralgia. Clinical diagnosis is difficult because of the overlying features between primary headaches such as migraine, tension-type headache, and CH. Interventional pain physicians have focused on supporting the clinical diagnosis of CH with confirmatory blocks. The treatment of cervical facet arthropathy as the source of CH is best approached with a multidimensional plan focusing on physical therapy and/or manual therapy. The effective management of occipital neuralgia remains challenging, but both injections and neuromodulation are promising options.

Cervicogenic headache, Occipital neuralgia, Cervical facet arthropathy, Occipital nerve stimulation, Occipital nerve block

CURRENT PAIN AND HEADACHE REPORTS

Volume 14, Number 6, 418-423, DOI: 10.1007/s11916-010-0151-5

J. D. Hoppenfeld

Abstract

Cervicogenic headache (CH) is pain referred from the neck. Two common causes are cervical facet arthropathy and occipital neuralgia. Clinical diagnosis is difficult because of the overlying features between primary headaches such as migraine, tension-type headache, and CH. Interventional pain physicians have focused on supporting the clinical diagnosis of CH with confirmatory blocks. The treatment of cervical facet arthropathy as the source of CH is best approached with a multidimensional plan focusing on physical therapy and/or manual therapy. The effective management of occipital neuralgia remains challenging, but both injections and neuromodulation are promising options.

Occipital Nerve Blocks: When and What to Inject?

Headache: The Journal of Head and Face Pain

Volume 49 Issue 10, Pages 1521 - 1533 Published Online: 6 Aug 2009 Copyright © 2009 American Headache Society

Joshua Tobin, MD; Stephen Flitman, MD

From 21st Century Neurology – Neurology, Phoenix, AZ, USA.

Correspondence to J. Tobin, 21st Century Neurology – Neurology, 2601 North Third Street Suite 125, Phoenix, AZ 85004, USA.

Conflict of Interest: None

ABSTRACT

Introduction.—Occipital nerve block (ONB) is a promising treatment for headaches. Its indications, selection criteria, and best techniques are not clear, however.

Objective.—To summarize in narrative format what is known about ONBs and what needs to be learned.

Methods.—MD Consult and Google Scholar were searched using the terms occipital, suboccipital, block, and injection to identify relevant articles that were reviewed. This process was repeated for all additional pertinent articles identified from these articles, and so on, until no additional articles were identified.

Results.—A total of 21 articles were identified.

Conclusions.—Occipital nerve block is an effective treatment for cervicogenic headache, cluster headache, and occipital neuralgia. While a double blinded randomized placebo controlled clinical trial is lacking, multiple open label studies reported favorable results for migraine. Two other possible uses of ONB worthy of further study are use as a rescue treatment and as an adjunctive treatment for medication overuse headache. ONB may be effective for tension headache, but only under very specific circumstances. ONB is either ineffective or only effective under as yet unstudied circumstances for hemicrania continua and chronic paroxysmal hemicrania. Some practitioners use occipital nerve (ON) tenderness to palpation (TTP) or reproduction of headache pain with ON pressure (RHPONP) as selection criteria for identifying appropriate patients. While only a clinical trial can produce a definitive answer, current evidence suggests that these selection criteria are not necessary for cervicogenic headache or cluster headache. Occipital neuralgia by definition involves TTP of the ONs. Whether RHPONP or ON TTP predicts success in migraine is unclear, and may relate to whether steroids are used. A single blinded randomized controlled trial evaluating local anesthetic with steroids vs local anesthetic alone for transformed migraine reported slightly worse results with steroids, but there are several alternate explanations for this finding other than steroids being counterproductive. The technique of repetitive ONBs deserves further study.