A Totzeck

C Gaul

H Shanib

HC Diener

J Roguski

K Görlinger

R Weber

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POSTER PRESENTATION Open Access
Efficacy and safety of occipital nerve blocks in
cluster headache: a prospective observational
study
C Gaul1*, J Roguski2, H Shanib2, A Totzeck2, K Görlinger3, HC Diener3, R Weber4
From The European Headache and Migraine Trust International Congress
London, UK. 20-23 September 2012
Background
Cluster headache (CH) is characterized by severe trige-
mino-autonomic cephalagias. Treatment of CH consists
of acute attack aborting and prophylactic strategies.
However, a substantial number of patients do not have
sufficient control of CH attacks despite oxygen inhala-
tion, triptans, oral steroids and verapamil. To date only
two small randomized trial and retrospective case series
have investigated the efficacy and safety of occipital
nerve blocks in CH.
Methods
The effect of a single infiltration of the ipsilateral greater
and lesser occipital nerve using a long-acting corticosteroid
(10 mg triamcinolone) and anaesthetic (Bupivacaine 0.5%)
was prospectively investigated in 101 CH patients
(61 episodic CH, 40 chronic CH) who did not have suffi-
cient control of CH attacks in a tertiary headache center
during July 2010 and November 2011. Attack frequency,
pain intensity and side effects were recorded by repetitive
standardized interviews at days 3 and 7 after infiltration
and thereafter weakly until reoccurrence of attacks.
Results
The mean attack frequency was 2.9 ± 2.5 (eCH) and 3.3 ±
2.9 (cCH) at baseline. This was reduced to 2.2 ± 1.7 (eCH)
respective 2.5 ± 2.3 (cCH) after 7 days. 67.2% (eCH) and
50% (cCH) became attack free. 10.9% of the patients
reported at least one side effect. Most frequent side effects
were: nausea (0.9%), pressure (0.9%) or pain (1.8%) at the
injection site, tension type headache (4.6%) and
retroorbital pain (1.8%). 83% of patients would repeat
nerve block treatment.
Conclusion
Occipital nerve block is an easy, safe and effective treat-
ment option for exacerbation of eCH and cCH which
can suppress attacks temporarily in a high number of
patients with eCH and cCH and results in a complete
response in a substantial number of patients with eCH.
Author details
1Migraine- and Headache Clinic Königstein, Germany. 2Headache Center
Universityhoispital Essen, Germany. 3University Hospital Essen, UK. 4University
Hospital Essen, Germany.
Published: 21 February 2013
Reference
1. Leroux E, Valade D, Taifas I, Vicaut E, Chagnon M, Roos C, Ducros A:
Suboccipital steroid injections for transitional treatment of patients with
more than two cluster headache attacks per day: a randomised, double-
blind, placebo-controlled trial. Lancet Neurol 2011, 10:891-7.
doi:10.1186/1129-2377-14-S1-P60
Cite this article as: Gaul et al.: Efficacy and safety of occipital nerve
blocks in cluster headache: a prospective observational study. The
Journal of Headache and Pain 2013 14(Suppl 1):P60.
1Migraine- and Headache Clinic Königstein, Germany
Full list of author information is available at the end of the article
Gaul et al. The Journal of Headache and Pain 2013, 14(Suppl 1):P60
http://www.thejournalofheadacheandpain.com/content/14/S1/P60
© 2013 Gaul et al; licensee Springer. This is an Open Access article distributed under the terms of the Creative Commons Attribution
License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium,
provided the original work is properly cited.


Efficacy and safety of occipital nerve blocks in cluster headache: a prospective observational study

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Efficacy and safety of occipital nerve blocks in cluster headache: a prospective observational study

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