Multiple cranial nerve blocks for the transitional treatment of chronic headaches. (October 2019)

• Record Type: Journal Article
• Authors: Miller, Sarah; Lagrata, Susie; Matharu, Manjit
• Is Part Of: Cephalalgia. Volume 39:Number 12(2019)
• Page Start: 1488
• Page End: 1499
• Publication Date: 2019-10
• Subjects: Nerve block -- migraine -- cluster headache -- new daily persistent headache -- paroxysmal hemicrania -- short lasting unilateral neuralgiform attack disorders; Headache -- Periodicals; 616.8491
• DOI: 10.1177/0333102419848121
• Languages: English
• ISSNs: 0333-1024

Abstract

Background: Multiple cranial nerve blocks of the greater and lesser occipital, supraorbital, supratrochlear and auriculotemporal nerves are widely used in the treatment of primary headaches. We present efficacy and safety data for these procedures. Methods: In an uncontrolled open-label prospective study, 119 patients with chronic cluster headache, chronic migraine, short lasting unilateral neuralgiform attack disorders, new daily persistent headaches, hemicrania continua and chronic paroxysmal hemicrania were examined. All had failed to respond to greater occipital nerve blocks. Response was defined as a 50% reduction in either daily attack frequency or moderate-to-severe headache days after 2 weeks. Results: The response rate of the whole cohort was 55.4%: Chronic cluster headache, 69.2%; chronic migraine, 49.0%; short lasting unilateral neuralgiform attack disorders, 56.3%; new daily persistent headache, 10.0%; hemicrania continua, 83.3%; and chronic paroxysmal hemicrania, 25.0%. Time to benefit was between 0.50 and 33.58 hours. Benefit was maintained for up to 4 weeks in over half of responders in all groups except chronic migraine and paroxysmal hemicrania. Only minor adverse events were recorded. Conclusion: Multiple cranial nerve blocks may provide an efficacious, well tolerated and reproducible transitional treatment for chronic headache disorders when greater occipital nerve blocks have been unsuccessful.