The effect of greater occipital nerve blockade on the quality of life, disability and comorbid depression, anxiety, and sleep disturbance in patients with chronic migraine

Abstract Background The CGRP antagonists offer a novel therapeutic approach in migraine. Their utility in patients with severe forms of chronic migraine is a subject of particular interest. We present outcomes of 9 months of erenumab treatment in a cohort of patients with difficult-to-control chronic migraine, all of whom had prior unsatisfactory response to onabotulinumtoxinA. Methods We offered erenumab to 98 patients with a prior unsatisfactory response to onabotulinumtoxinA. Eighty of 98 had trialled greater occipital nerve injections (82%), 32/98 peripheral neurostimulation (33%) and 18/98 intravenous dihydroergotamine (18%). Thirty eight of 98 (39%) met the definition of triptan overuse and 43/98 (44%) analgesic overuse. All patients met the EHF criteria for ‘resistant migraine’. Outcome measures (recorded monthly) included days with headache limiting activities of daily living (“red”), not limiting (“amber”), headache free (“green”), and requiring triptans or other analgesics. Quality of life scores - headache impact test 6 (HIT-6), patient health questionnaire 9 (PHQ-9) and pain disability index (PDI) - were also measured. Results Mean number of red days improved by − 6.4 days (SE 0.67, 95%CI − 7.7 to − 5.1, p=0.001) at 3 months; − 6.8 days (SE 0.96, 95%CI − 8.80 to − 4.9, p=0.001) at 6 months and − 6.5 days (SE 0.86, 95%CI − 8.3 to − 4.8, p=0.001) at 9 months. Repeated measures ANOVA confirmed improvements in the number of red (p=0.001), green (p=0.001), triptan (p=0.001) and painkiller days (p=0.001) as well as scores of the HIT-6 (p=0.001), PHQ-9 (p=0.001), and PDI (p=0.001) across the duration of study. Conclusion We observed improvements in pain, medication use and quality of life in onabotulinumtoxinA-resistant chronic migraine patients following erenumab treatment.

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Addition of lesser occipital nerve blockade to greater occipital nerve blockade in patients with chronic migraine

Neurology Asia ◽

10.54029/2021cdz ◽

2021 ◽

Vol 26 (4) ◽

pp. 731-736

Author(s):

Tülin Aktürk ◽

Hikmet Saçmacı ◽

Hanzade Aybüke Ünal Artık ◽

Nermin Tanık ◽

Levent Ertuğrul İnan

Keyword(s):

Chronic Migraine ◽

Clinical Characteristics ◽

Control Group ◽

Nerve Blockade ◽

Occipital Nerve ◽

Results Of Treatment ◽

Greater Occipital Nerve ◽

Group A ◽

Vas Scores ◽

Group B

Objectives: The aim of this study was to compare greater occipital nerve blockade (GONB) alone and GONB combined with lesser occipital nerve blockade (LONB) in chronic migraine patients. Methods: Patients were randomly divided into two groups: Group A consisted of 22 patients who received only GONB; while Group B consisted of 20 patients who underwent GONB and LONB. The demographics and clinical characteristics of the patients were evaluated. The injections were given unilaterally and to the side where the subjects experienced greater pain. GONB with or without LONB was performed on each patient once a week for 4 weeks and then two more times a month apart; 6 times in total. The number of headache days, severity of attacks and duration of headache episodes was recorded from headache diaries before treatment and the on the first, second and third month following the start of treatment. Treatment efficiencies were evaluated within and between the groups. Results: The duration of pretreatment headaches was significantly longer in Group B (p=0.032). There were no differences between the groups in terms of other demographic and clinical characteristics. When the treatments applied in group A and group B were evaluated separately compared to the control group, there was a statistically significant decrease in the number of headache days, VAS scores and headache duration (p <0.05). When the results of treatment between groups were compared, there was no difference in terms of the number of headache days and VAS scores. Although the duration of headache was longer in the pretreatment period in group B, this difference disappeared on posttreatment follow-up (p>0.05). Conclusions: This study suggests that there is no difference in the number of headache days or headache intensity between GONB alone or in combination with LONB in chronic migraine patients. GONB combined with LONB in patients may be more effective than GONB alone when headaches of longer duration are present.

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Clinical success of greater occipital nerve blockade in improving sleep quality of chronic migraineurs: a prospective observational study

Sleep And Breathing ◽

10.1007/s11325-021-02309-z ◽

2021 ◽

Author(s):

Hikmet Saçmacı ◽

Tülin Aktürk ◽

Nermin Tanık ◽

Levent Ertuğrul İnan

Keyword(s):

Observational Study ◽

Sleep Quality ◽

Prospective Observational Study ◽

Clinical Success ◽

Nerve Blockade ◽

Occipital Nerve ◽

Greater Occipital Nerve ◽

Chronic Migraineurs

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The efficacy of greater occipital nerve blockade in chronic migraine: A placebo-controlled study

Acta Neurologica Scandinavica ◽

10.1111/ane.12716 ◽

2016 ◽

Vol 136 (2) ◽

pp. 138-144 ◽

Cited By ~ 25

Author(s):

H. L. Gul ◽

A. O. Ozon ◽

O. Karadas ◽

G. Koc ◽

L. E. Inan

Keyword(s):

Chronic Migraine ◽

Controlled Study ◽

Nerve Blockade ◽

Occipital Nerve ◽

Greater Occipital Nerve

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Occipital Nerve Stimulation for Chronic Migraine: A Randomized Trial

January 2018 - Pain Physician ◽

10.36076/ppj.2012/15/245 ◽

2012 ◽

Vol 3;15 (3;5) ◽

pp. 245-253 ◽

Cited By ~ 9

Author(s):

Dr. Gerardo Serra

Keyword(s):

Quality Of Life ◽

Chronic Migraine ◽

Nerve Stimulation ◽

Drug Intake ◽

Occipital Nerve Stimulation ◽

Occipital Nerve ◽

Number Of Patients ◽

One Year

Background: Chronic migraine (CM) and medication overuse headache (MOH) are disabling conditions that may be only partially managed with conservative treatments. Occipital nerve stimulation (ONS) is an innovative treatment for headache disorders. Objectives: To investigate the safety and efficacy of ONS for CM and MOH patients and to evaluate changes in disability, quality of life, and drug intake in implanted patients. Study Design: Prospective, randomized cross-over study. Methods: Eligible patients who responded to a stimulation trial underwent device implantation and were randomized to “Stimulation On” and “Stimulation Off” arms. Patients crossed over after one month, or when their headaches worsened. Stimulation was then switched On for all patients. Disability as measured by the Migraine Disability Assessment (MIDAS), quality of life (SF-36), and drug intake (patient’s diary) were assessed over a one-year follow-up. Results: Thirty-four patients (76% women, 34% men, mean age: 46 ± 11 years) were enrolled; 30 were randomized and 29 completed the study. Headache intensity and frequency were significantly lower in the On arm than in the Off arm (P < 0.05) and decreased from the baseline to each follow-up visit in all patients with Stimulation On (median MIDAS A and B scores: baseline = 70 and 8; one-year follow-up = 14 and 5, P < 0.001). Quality of life significantly improved (P < 0.05) during the study. Triptans and nonsteroidal anti-inflammatory drug use fell dramatically from the baseline (20 and 25.5 doses/month) to each follow-up visit (3 and 2 doses/month at one year, P < 0.001). A total of 5 adverse events occurred: 2 infections and 3 lead migrations. Limitations: Single-centre study, relatively small number of patients, absence of a control group. Conclusions: According to the results obtained, ONS appears to be a safe and effective treatment for carefully selected CM and MOH patients. Key words: Occipital nerve stimulation, chronic migraine, headache attacks, quality of life, cross-over

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