Greater occipital nerve block (GONB) along with triamcinolone and local anesthetic substantially improved characteristics of headache attacks in medication overuse headache (MOH).

This study was carried out to explore the effectiveness of GONB in the detoxification process.

This open-label, parallel, randomized controlled clinical trial comprised of 54 patients with MOH and assigned to group A (27 patients) or B (27 patients). The participants in both groups underwent detoxification processes without using acute migraine medicines or painkillers. During the initial 10 days, all the participants were given maximally 300 mL promethazine syrup (5 mg per 5 mL) to be used 10 mg every 8 hours.

Patients in group A were given a 2-mL syringe containing a combination of  1 mL of 40 mg/mL triamcinolone and 1 mL of 2% lidocaine for performing GONB. The characteristics of headache attacks (headache duration, severity, and frequency) were evaluated at the starting of the study and after three months.

Overall, 26 patients in group A (96.3%) and 23 patients in group B (85.2%) accomplished detoxification and were thus treated. The use of GONB along with local anesthetic and triamcinolone was found to remarkably improve the headache frequency, duration of headache, and headache severity in group A in comparison with the control group, as shown in Table 1:

Although both the detoxification programs were effective for MOH patients, detoxification with GONB demonstrated better outcomes.