Midterm Clinical Outcomes of Ultrasound-Guided Bilateral C2 Level Greater Occipital Nerve Block in Patients with Chronic Migraine

Outcomes of greater occipital nerve block in chronic migraine

Abstract

Introduction: The overall estimated prevalence of chronic migraine is 0.7%–5.1%, leading to a social, emotional, and economic burden. Literature data have shown the short-term efficacy of greater occipital nerve block in chronic migraine. This study aimed to assess the midterm clinical outcomes of four sessions of ultrasound-guided bilateral greater occipital nerve (GON) block at the C2 level. In addition, it evaluated the factors that may be associated with clinical success.

Methods: This was a single-center retrospective analysis. Demographic data, pre-procedural Beck Anxiety and Depression Inventory (BAI/BDI) scores, headache frequency in a month, headache days in a month, mean headache attack duration (hours), mean pain intensity (Visual Analog Scale 0–100 mm), Migraine Disability Assessment (MIDAS) grades, and Headache Impact Test—6 (HIT-6) levels at baseline and at 1-, 3-, and 6-month visits were evaluated. A reduction of 30% in headache days in a month was considered to be a clinical success.

Results: Headache frequency, headache days, mean headache attack duration, mean pain intensity, MIDAS grades, HIT-6 levels, and medication overuse improved at 1-, 3-, and 6-month visits according to the baseline (p < .001). There was no statistically significant correlation between clinical success at 6 months and age, disease duration, baseline attack duration, pain severity, MIDAS grades, HIT levels, BDI scores, and BAI scores (p = .279, .193, .160, .826, .068, .207, .389, and .076, respectively). 

Conclusion: Clinical improvement, reduction in disability and impact of headache, and even transformation to episodic migraine are possible with four sessions of GON block at the C2 level for 6 months in patients with chronic migraine. Also, clinical success at the 6-month visit was not related to age, migraine characteristics, baseline depression, anxiety, and disability scores.