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Greater occipital nerve blocks with bupivacaine is an
effective treatment approach for acute migraine patients visiting the emergency
department complaining of continuous moderate to severe headache after
metoclopramide consumption.
According to the research presented at American Headache
Society Annual Meeting, San Francisco, Greater occipital nerve block (GONB) may
demonstrate as an efficient method to treat moderate to severe headache among
emergency department (ED) patients with an acute migraine and on standard
therapy with intravenous metoclopramide. Of the ED patients, only 25% succeeded
to attain freedom from headache, despite the fact which medicine they received.
Most medications involved restlessness, drowsiness and dizziness. These issues
can be solved with the help of an approach known with the name of greater
occipital nerve blocks.
The scientists for this paper conducted a comparative
analysis to evaluate the GONB with
bupivacaine efficacy to reduce headache rates as compared to sham injection
among two urban EDs. Migraineurs with mild to severe headaches of 1 hr or
longer and 10 mg of intravenous metoclopramide were randomly divided into two
groups; bilateral intradermal scalp injection (1 mL of 0.5% bupivacaine) and
bilateral GONB (6 mL of 0.5% bupivacaine). The complete relief from headache
within 30 minutes after the dose was considered the primary outcome. Sustained
headache relief involved achievement of headache level mild or none and
maintain that level without the use of any supplementary headache medications
(48 hrs) was taken as a secondary outcome.
A total of 76 patients were chosen; out of which 28 were selected and provided with GONB (n = 13) and sham injection (n = 15). The study was terminated before obtaining the a priori sample size due to slow registration. The GONB group showed 31% response as compared to 0% response by the sham group with concern to headache freedom at 30 minutes ( P = .035). Further, sustained headache relief for 48 hours was noticed more in GONB group (95%) as compared to the sham group (23%); P = .087. No difference was seen between the groups concerning the side effects. GONB may exhibit significant safety and efficacy to treat episodes of headaches among ED patients, but the study was closed before attaining the a priori sample size.
Headache
A Randomized, Sham-Controlled Trial of Bilateral Greater Occipital Nerve Blocks With Bupivacaine for Acute Migraine Patients Refractory to Standard Emergency Department Treatment With Metoclopramide.
Benjamin W. Friedman et al.
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