Greater Occipital Nerve Block Effective for Acute Relief of Refractory Migraine

Posted on by Dr Clemens

In patients in which intravenous metoclopramide fails to relieve moderate or severe headache, greater occipital nerve block with bupivacaine may be an effective treatment, according to study results presented at the 2018 American Headache Society Annual Scientific Meeting, June 28-July 1, 2018, in San Francisco, California.

The randomized, 32-month study conducted in 2 urban emergency departments included 28 patients with acute moderate or severe migraine whose pain persisted for at least 1 hour post treatment with 10 mg intravenous metoclopramide. The patients were randomly assigned to receive either bilateral greater occipital nerve block with 6 cc 0.5% bupivacaine (n=13) or sham injection (n=15).

The primary outcome of headache freedom at 30 minutes post injection was achieved by 31% of patients in the treatment arm compared with none in the sham arm (95% CI, 6%-56%). Notably, 23% of patients in the treatment arm reported sustained headache relief for 48 hours post injection, compared with none in the sham group (95% CI, 0%-46%). The investigators noted that adverse effects were similar between both groups.

Greater occipital nerve block may be an effective and lasting treatment for patients whose acute migraine is not improved with standard care.

Reference

Friedman B, Mohamed S, Irizarry E, Robbins M. A randomized, sham-controlled trial of bilateral greater occipital nerve blocks with bupivacaine for acute migraine patients refractory to standard emergency department treatment with metoclopramide. Presented at: 2018 American Headache Society Annual Scientific Meeting. June 28-July 1, 2018; San Francisco, CA. Abstract 487904.

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