scholarly journals Postural physiotherapy for cervicogenic headache after occipital nerve block: a retrospective study

2021 ◽  
Vol 10 (12) ◽  
pp. e165101219994
Author(s):  
Alcântara Ramos de Assis César ◽  
Igor Dal Pozzo da Costa ◽  
Wesley Gabriel Novaes Botelho ◽  
Nicole Sperafico ◽  
Anderson Dillmann Groto ◽  
...  
Keyword(s):  
Physical Therapy ◽  
Pain Score ◽  
Nerve Block ◽  
Therapy Group ◽  
Cervicogenic Headache ◽  
Pain Scale ◽  
Occipital Nerve ◽  
Group I ◽  
Occipital Nerve Block ◽  
Hip Rotation

Cervicogenic headache has a complex and poorly understood pathophysiology. Symptoms are typical and involve the C2 and C3 nerve roots. There are no specific recommendations for physical therapy, although occipital nerve block is a known pharmacological treatment. Some evidence suggests that hip rotation correction could aid in reducing cervical pain symptoms. The objective of this work is to evaluated the role of postural physiotherapy for hip rotation correction using the Maitland technique in patients with cervicogenic headache who underwent an occipital nerve block. In this retrospective, observational and uncontrolled study, patients were evaluated from January 2017 to February 2018. After diagnosis of cervicogenic headache they underwent anesthetic block, hip radiography with lower limb scanometry and cervical tomography, after which they were referred to physical therapy. The analog pain scale was used for evaluation at the time of diagnosis and after the proposed physiotherapy. Patients submitted to an occipital nerve block were divided into three groups: Group I (n = 15, physical therapy with Maitland technique) had an analog pain score of 1.6 after the physical therapy, Group II (n = 11, conventional physiotherapy) had an analog pain score of 3.7 after the physical therapy and Group III (n = 13, occipital nerve block only) had an analog pain score of 5.2 after the occipital nerve block. The results suggest that an occipital nerve block in combination with the Maitland technique is superior in patients with cervicogenic headache compared to nerve block only or blockade combined with non-specific physical therapy (p=0,013).

Occipital Neuralgia

2018 ◽  
pp. 287-292
Author(s):  
Armin Deroee ◽  
Jianguo Cheng
Keyword(s):  
Nerve Block ◽  
Primary Headache ◽  
Headache Disorder ◽  
Cervicogenic Headache ◽  
Occipital Neuralgia ◽  
Occipital Nerve ◽  
Primary Headache Disorder ◽  
Greater Occipital Nerve ◽  
Occipital Nerve Block ◽  
Injection Pulse

Occipital neuralgia is a primary headache disorder characterized by intermittent, sharp stabbing occipital pain. Diagnosis is made by history, clinical examination, and positive response to anesthetic block of the greater occipital nerve. Occipital neuralgia should be differentiated from cervicogenic headache, migraines, and other causes of headaches as some of them may manifest with similar symptoms, including occipital pain and allodynia, and may also respond to occipital nerve block. Conservative treatment with physical therapy and low-dose antiepileptics or tricyclic antidepressants can be effective. Refractory cases may respond to occipital nerve block, Botox injection, pulse radiofrequency, or occipital nerve stimulation.

scholarly journals The efficacy of ultrasound-guided multifidus cervicis plane block versus greater occipital nerve block for cervicogenic headache

2021 ◽  
Vol 57 (1) ◽  
Author(s):  
Zenat Eldadamony Mohamed ◽  
Carmen Ali Zarad ◽  
Mohamed E. Flifel ◽  
Ali A. Abou Elmaaty
Keyword(s):  
Nerve Block ◽  
Cervicogenic Headache ◽  
Invasive Technique ◽  
Ultrasound Guided ◽  
Occipital Nerve ◽  
Median Reduction ◽  
Greater Occipital Nerve Block ◽  
Greater Occipital Nerve ◽  
Significant Difference ◽  
Occipital Nerve Block

Abstract Introduction Traditionally, non-invasive and invasive techniques were used for the treatment of cervicogenic headache (CH). Greater occipital nerve block is the most frequent peripheral nerve block invasive technique used for the management of cervicogenic headache. The purpose of this prospective, double-blinded study was to compare the efficacy of two different techniques: multifidus cervicis plane block and greater occipital nerve block in the treatment of refractory cervicogenic headache by using ultrasound. Methods Sixty patients with cervicogenic headache were recruited and diagnosed according to the ICHD-III beta version. The patients were divided into two groups, one group was for greater occipital nerve block and the other group was for multifidus cervicis plane block with ultrasound-guided. Results Visual analog scale (VAS) was 2.09% in the multifidus cervicis plane block (MCPB) group and was 2.22% in the greater occipital nerve block (GONB) group with a median reduction of − 4.33 and − 3.048, respectively, at 2-week visits with a statistically significant difference better in the MCPB group (P < 0.001). At 4 weeks visits, VAS scale was better in the MCPB group than in the GONB group (3.79 and 4.44, respectively) with a median reduction in VAS scale (− 3.27 and − 3.095, respectively) and statistically significant differences between both groups (P = 0.020). Conclusion Both the ultrasound-guided multifidus cervicis plane block and greater occipital nerve block are effective as intervention techniques in the treatment of refractory cervicogenic headache. These techniques are simple, safe, more reliable with less side effects, and often reduce the requirements of analgesic drugs.

Occipital nerve block for the short-term preventive treatment of migraine: A randomized, double-blinded, placebo-controlled study

Cephalalgia ◽  
2014 ◽  
Vol 35 (11) ◽  
pp. 959-968 ◽  
Author(s):  
Esma Dilli ◽  
Rashmi Halker ◽  
Bert Vargas ◽  
Joseph Hentz ◽  
Teresa Radam ◽  
...  
Keyword(s):  
Chronic Migraine ◽  
Nerve Block ◽  
Preventive Treatment ◽  
Placebo Treatment ◽  
Baseline Period ◽  
Controlled Study ◽  
Double Blind ◽  
Occipital Nerve ◽  
Occipital Nerve Block ◽  
Severe Migraine

Background Occipital nerve (ON) injections with corticosteroids and/or local anesthetics have been employed for the acute and preventive treatment of migraine for decades. However, to date there is no randomized, placebo-controlled evidence to support the use of occipital nerve block (ONB) for the prevention of migraine. Objective The objective of this article is to determine the efficacy of ONB with local anesthetic and corticosteroid for the preventive treatment of migraine. Participants and methods Patients between 18 and 75 years old with ICHD-II-defined episodic (> 1 attack per week) or chronic migraine (modified ICHD-II as patients with > 10 days with consumption of acute medications were permitted into the study) were randomized to receive either 2.5 ml 0.5% bupivacaine plus 0.5 ml (20 mg) methylprednisolone over the ipsilateral (unilateral headache) or bilateral (bilateral headache) ON or 2.75 ml normal saline plus 0.25 ml 1% lidocaine without epinephrine (placebo). Patients completed a one-month headache diary prior to and after the double-blind injection. The primary outcome measure was defined as a 50% or greater reduction in the frequency of days with moderate or severe migraine headache in the four-week post-injection compared to the four-week pre-injection baseline period. Results Thirty-four patients received active and 35 patients received placebo treatment. Because of missing data, the full analysis of 33 patients in the active and 30 patients in the placebo group was analyzed for efficacy. In the active and placebo groups respectively, the mean frequency of at least moderate (mean 9.8 versus 9.5) and severe (3.6 versus 4.3) migraine days and acute medication days (7.9 versus 10.0) were not substantially different at baseline. The percentage of patients with at least a 50% reduction in the frequency of moderate or severe headache days was 30% for both groups (10/30 vs nine of 30, Δ 0.00, 95% CI –0.22 to 0.23). Conclusions Greater ONB does not reduce the frequency of moderate to severe migraine days in patients with episodic or chronic migraine compared to placebo. The study was registered with ClinicalTrial.gov (NCT00915473).

A Randomized Comparison Between Ultrasound- and Fluoroscopy-Guided Third Occipital Nerve Block

2013 ◽  
Vol 38 (3) ◽  
pp. 212-217 ◽  
Author(s):  
Roderick J. Finlayson ◽  
John-Paul B. Etheridge ◽  
Lucy Vieira ◽  
Gaurav Gupta ◽  
De Q.H. Tran
Keyword(s):  
Nerve Block ◽  
Occipital Nerve ◽  
Occipital Nerve Block

Greater occipital nerve block modulates nociceptive signals within the trigeminocervical complex

2021 ◽  
pp. jnnp-2021-326433
Author(s):  
Jan Hoffmann ◽  
Jan Mehnert ◽  
Elena M Koo ◽  
Arne May
Keyword(s):  
Nerve Block ◽  
Clinical Effects ◽  
Double Blind ◽  
Occipital Nerve ◽  
Randomised Study ◽  
In Vivo Experiments ◽  
Greater Occipital Nerve Block ◽  
Greater Occipital Nerve ◽  
Occipital Nerve Block

IntroductionThe pharmacological block of the greater occipital nerve has been proven effective in numerous headache and facial pain syndromes. This clinical effect supports the hypothesis of a strong functional interaction between the occipital and trigeminal nerves which has been proposed in neurophysiological in vivo experiments in rodents. Although it is likely that the interaction has to occur in the central nervous system, the exact site and the mechanisms of the interaction remain largely unknown.MethodsFocusing on these questions we investigated in a double-blind, placebo-controlled, randomised study the influence of an occipital nerve block with lidocaine 1% on neuronal activation in the trigeminocervical complex using high-resolution functional magnetic resonance on a 3T scanner. In order to investigate potential clinical effects on the trigeminal nerve, we further performed quantitative sensory testing and analysed a potential shift in thermal detection and pain thresholds.ResultsThe pharmacological block of the greater occipital nerve induced an occipital anaesthesia ipsilateral to the block. Functional imaging revealed that the occipital injection of lidocaine but not placebo significantly reduced nociceptive trigeminal activation.ConclusionsThese data suggest that the functional inhibition of the occipital nerve block on trigeminal nociceptive activity is likely to occur at the C2 level where the occipital nerve enters the trigeminocervical complex and converges on the same central nuclei before the signal crosses the midline at that level and is then transmitted to higher processing centres.

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