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Presently, there is no evidence to guide the acute treatment of migraine aura.
Migraine
encompass numerous encephalic structures in its pathophysiology with the
trigeminal nerve (TN) type being one of the crucial ones. The greater occipital
nerve block (GON) explained in this study is a simple, safe and effective
technique for migraine aura treatment.
Presently, there
is no evidence to guide the acute treatment of migraine aura. We aimed to
describe the effect of greater occipital nerve (GON) anesthetic block as a
symptomatic treatment for long-lasting (prolonged or persistent) migraine aura.
Patients who
presented with migraine aura lasting > 2 hours were consecutively recruited
during one year at the Headache Unit and the Emergency Department of a tertiary
hospital. All patients underwent a bilateral GON block with bupivacaine 0.5%.
Patients were followed up for 24 hours.
A total of 22
auras were treated in 18 patients. Auras consisted of visual (n = 13), visual
and sensory (n = 4) or sensory symptoms alone (n = 5). Eleven episodes met
diagnostic criteria for persistent aura (>1 week) without infarction. The
response was complete without early recurrence in 11 cases (50%), complete with
recurrence in < 24 hours in two cases (9.1%), and partial with ≥ 50%
improvement in six cases (27.3%). Complete responses without recurrence were
more common in cases with prolonged auras lasting < 1 week than in those
with persistent auras (72.7% vs. 27.3%; p = 0.033).
GON block could
be an effective symptomatic treatment for prolonged or persistent migraine
aura. Randomised controlled trials are still required to confirm these results.
Cephalalgia
Greater occipital nerve block for the acute treatment of prolonged or persistent migraine aura
María L Cuadrado et al.
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