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Greater Occipital Nerve Block in Management of Acute Migraine Headache

April 2, 2018
Veronica Hackethal, MD

In the largest study to date of blockade of the greater occipital nerve for migraine treatment, more than half of patients claimed a 50% reduction in pain. 

New support for a peripheral mechanism underlying migraine etiology.

Largest Study on GON Block for Migraine. GON block often used for migraine, but evidence about its effectiveness is lacking. No current guidelines recommend GON block for migraine.

Retrospective Cohort Study at Mayo Clinic in Arizona. 562 patients with at least one GON block alone or combined with other migraine treatments between January 2009 to August 2014.

GON Block Effective for Acute Migraine. More than half of subjects reported more than 50% reduction in pain; receipt of 2 or more GON blocks was associated with 5 times higher odds of responding, vs one GON block (p<.001).

Clinical Considerations. Patients with a good response to one GON block may be more likely to return for another treatment; time in between treatments may impact efficacy; study cannot determine response for anesthetic alone.
 

Take Home Points

  • Largest study of its kind suggests GON block is effective for treating acute migraine
  • 82% of patients had a moderate to significant response of ≥30% decrease in pain from baseline
  • Younger patients and those with two or more GON blocks were more likely to respond
  • No significant differences based on sex, past treatments, anesthetic concentration or dose
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Blockade of the greater occipital nerve is routinely used to treat acute migraine headache although there is a dearth of conclusive clinical evidence to support the procedure. The current study sought to assess the efficacy of the intervention with a focus in pain relief as the primary outcome. While the study has its limitations, it is a meaningful contribution to the body of evidence in support of a peripheral mechanism underlying migraine etiology.Get a top-line look at the study and its results in the short slide show above.Source: Allen SM, Mookadam F, Cha SS, et al. Greater occipital nerve block for acute treatment of migraine headache: a large retrospective cohort study. J Am Board Fam Med. 2018;31:211-218. doi: 10.3122/jabfm.2018.02.170188.