Occipital neuroma triggered cluster headache responding to greater occipital nerve blockade

Cluster headache is perhaps the most painful of the primary headache disorders. Its treatment includes acute, transitional, and preventive therapy. Despite the availability of many treatments, cluster headache patients can still be difficult to treat. We treated 14 cluster headache patients with greater occipital nerve block as transitional therapy (treatment initiated at the same time as preventive therapy). The mean number of headache-free days was 13.1+23.6. Four patients (28.5%) had a good response, five (35.7%) a moderate, and five (35.7%) no response. The greater occipital nerve block was well tolerated with no adverse events. Headache intensity, frequency and duration were significantly decreased comparing the week before with the week after the nerve block ( P< 0.003, P = 0.003, P< 0.005, respectively). Greater occipital nerve blockade is a therapeutic option for the transitional treatment of cluster headache.

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Authors' Reply: Greater Occipital Nerve Blockade for Cluster Headache

Cephalalgia ◽

10.1046/j.1468-2982.2003.05222.x ◽

2003 ◽

Vol 23 (4) ◽

pp. 323-323 ◽

Cited By ~ 4

Author(s):

Mario F. P. Peres ◽

M Alan Stiles ◽

Hua Charles Siow ◽

William B. Young ◽

Stephen D. Silberstein ◽

...

Keyword(s):

Cluster Headache ◽

Nerve Blockade ◽

Occipital Nerve ◽

Greater Occipital Nerve

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Occipital Nerve Blockade in Chronic Cluster Headache Patients and Functional Connectivity Between Trigeminal and Occipital Nerves

Cephalalgia ◽

10.1111/j.1468-2982.2007.01424.x ◽

2007 ◽

Vol 27 (11) ◽

pp. 1206-1214 ◽

Cited By ~ 56

Author(s):

V Busch ◽

W Jakob ◽

T Juergens ◽

W Schulte-Mattler ◽

H Kaube ◽

...

Keyword(s):

Functional Connectivity ◽

Cluster Headache ◽

Clinical Symptoms ◽

Blink Reflex ◽

Chronic Cluster Headache ◽

Nerve Blockade ◽

Occipital Nerve ◽

Nociceptive Blink Reflex ◽

Greater Occipital Nerve ◽

Headache Patients

Headache syndromes often involve occipital and neck symptoms, suggesting a functional connectivity between nociceptive trigeminal and cervical afferents. Although reports regarding effective occipital nerve blockades in cluster headache exist, the reason for the improvement of the clinical symptoms is not known. Using occipital nerve blockade and nociceptive blink reflexes, we were able to demonstrate functional connectivity between trigeminal and occipital nerves in healthy volunteers. The R2 components of the nociceptive blink reflex and the clinical outcome in 15 chronic cluster headache patients were examined before and after unilateral nerve blockade of the greater occipital nerve with 5 ml prilocain (1%) on the headache side. In contrast to recent placebo-controlled studies, only nine of the 15 cluster patients reported some minor improvement in their headache. Six patients did not report any clinical change. Exclusively on the injection side, the R2 response areas decreased and R2 latencies increased significantly after the nerve blockade. These neurophysiological and clinical data provide further evidence for functional connectivity between cervical and trigeminal nerves in humans. The trigeminocervical complex does not seem to be primarily facilitated in cluster headache, suggesting a more centrally located pathology of the disease. However, the significant changes of trigeminal function as a consequence of inhibition of the greater occipital nerve were not mirrored by a significant clinical effect, suggesting that the clinical improvement of occipital nerve blockades is not due to a direct inhibitory effect on trigeminal transmission.

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