Refractory occipital scalp pruritus treated with computed tomography-guided greater occipital nerve ablation

SummaryOccipital neuralgia is a type of chronic headache disorder in the dermatomes of the greater or lesser occipital nerve. (7) We describe here a rare case of occipital neuralgia caused by an intramuscular lipoma. A 45 year-old man presented with troublesome pain in the occipital area with 3 x 2 cm palpable mass in the right occipital region. Patient was treated by a neurologist. The X ray for cervical vertebrae and computed tomography was performed.Computed tomography revealed a mass reminding intramuscular lipoma. Surgical management was indicated. During the operation stretching of the lesser occipital nerve was detected. After resection of lipoma on postoperative follow – up, the patient reported that the pain had resolved. During the histopathological examination, lipoma was confirmed.

Download Full-text

Sphenopalatine Ganglion versus Greater Occipital Nerve Blocks in Treating Post-Dural Puncture Headache after Spinal Anesthesia for Cesarean Section: A Randomized Clinical Trial

January 2018 - Pain Physician ◽

10.36076/ppj.2021.24.e443 ◽

2021 ◽

pp. E443-E451

Keyword(s):

Cesarean Section ◽

Dural Puncture ◽

Sphenopalatine Ganglion ◽

Ganglion Block ◽

Nerve Blocks ◽

Neck Stiffness ◽

Post Dural Puncture Headache ◽

Occipital Nerve ◽

Greater Occipital Nerve ◽

Blood Patch

BACKGROUND: Despite being invasive, with serious complications, epidural blood patch (EBP) is still considered the gold standard therapy for Post Dural Puncture Headache (PDPH). The use of Peripheral nerve blocks for PDPH are studied here. OBJECTIVES: To investigate the efficacy of sphenopalatine ganglion block (SPGB) and greater occipital nerve block (GONB) to relieve PDPH and its associated symptoms. STUDY DESIGN: Randomized comparative single-blind trial. SETTING: A University hospital. METHODS: Patients who received spinal anesthesia for elective cesarean section, and then developed PDPH during hospitalization or within 5 days after dural puncture were enrolled to receive GONB (n = 47) or SPGB (n = 46) for treatment of PDPH. GONB Group: Patients received bilateral GONB using 3 mL mixture of 2 mL lidocaine 2% plus 1 mL dexamethasone 4 mg on each side of occipital region. SPGB Group: Patients received bilateral SPGB using the same mixture in each nostril. Assessments included Numeric Rating Scale (NRS) for severity of headache at supine and sitting positions, nausea NRS, neck stiffness, need for EBP, and complications. RESULTS: The supine and sitting headache NRS scores significantly decreased at 30 minutes after blocks and throughout follow-up period in both groups (P < 0.000). Clinically significant drop of NRS to < 4 was reached earlier in GONB group. There was a significant difference between groups after 2 hours in supine and sitting headache NRS scores (P = 0.020 and 0.030, respectively); however, both treatments showed similar effectiveness from the third hour afterwards (P > 0.05). Both techniques were effective in relieving neck stiffness and nausea (P < 0.000), with no adverse effects. LIMITATIONS: A limitation to this study was the small sample size. CONCLUSIONS: GONB and SPGB are equally effective in relieving symptoms of PDPH. Both techniques are safe, simple, and less invasive than EBP. KEY WORDS: Cesarean Section, epidural blood patch greater occipital nerve block, post-dural puncture headache, sphenopalatine ganglion block

Download Full-text