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GREATER OCCIPITAL NERVE BLOCK MAY AFFECT THE EFFECTIVENESS OF TRIPTAN OVERUSE HEADACHE TREATMENT
Author(s):
PASZKOWSKA, M.*
Affiliations:
PAIN TREATMENT OFFICE, ANAESTHESIOLOGIST, SZCZECIN, Poland
ESRA Academy. Paszkowska M. Sep 13, 2017; 190724; 524 Topic: INTERVENTIONAL TECHNIQUES
Magdalena Paszkowska
Magdalena Paszkowska

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Abstract
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Background and Aims:

A 59 YO FEMALE PATIENT SUFFERING FROM MIGRAINE HEADACHES SINCE SHE TURNED 21. FOR MANY YEARS, THESE HEADACHES WERE PAROXYSMAL. IN NATURE, WITHOUT AURA. SINCE THE AGE OF 45 (DURING MENOPAUSE), MIGRAINE HEADACHES BECAME CHRONIC IN NATURE. FOR APPROXIMATELY 10 YEARS, SHE HAS BEEN TAKING SUMATRIPTAN, 100 MG PO 1-2 TIMES DAILY, OBTAINING EFFECTIVE SHORTTIME PAIN RELIEF (FOR A FEW HOURS).

Methods:

 DURING THE FIRST INTERVENTION, GONB WAS PERFORMED AT THE MEDIAL THIRD OF THE LINE BETWEEN THE EXTERNAL OCCIPITAL PROTUBERANCE AND THE MASTOID PROCESS. 3 ML OF 2% LIDOCAINE WAS ADMINISTERED BILATERALLY BY SUBCUTANEOUS INJECTION. THE SECOND BILATERAL GON BLOCK WAS PERFORMED UNDER ULTRASOUND GUIDANCE AT THE LEVEL OF C2. 4 ML OF 2% LIDOCAINE WAS ADMINISTERED BILATERALLY.

Results:

AFTER THE FIRST GREATER OCCIPITAL NERVE BLOCK, A FAVOURABLE ANALGESIC EFFECT WAS OBTAINED FOR 14 DAYS. THE PATIENT IN THIS PERIOD DID NOT TAKE TRIPTANS, HEADACHES OCCURRED OCCASIONALLY , RESPONDING WELL TO PARACETAMOL OR IBUPROFEN.AFTER THIS 14 –DAYS PERIOD PATIENT RETURNED TO TRIPTANS TREATMENT.DUE TO A SHORT-TERM EFFECT, A SECOND BLOCK WAS PERFORMED WHICH PROVED TO BE MORE EFFECTIVE. FOR APPROXIMATELY 3 MONTHS, THE PATIENT HAS NOT BEEN TAKING TRIPTANS, THE NUMBER OF DAYS WITH HEADACHES AND THE INTENSITY OF HEADACHES HAVE SUBSTANTIALLY DECREASED.

Conclusions:

OVER THE LAST FEW YEARS, GREATER OCCIPITAL NERVE BLOCK HAS BECOME AN EFFECTIVE METHOD IN THE TREATMENT OF MIGRAINE HEADACHES, ALSO THOSE CAUSED BY THE OVERUSE OF TRIPTANS. TO ACHIEVE A SATISFACTORY EFFECT, IT IS WORTH USING DIFFERENT TECHNIQUES OF GREATER OCCIPITAL NERVE BLOCK.

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