Efficacy of Greater Occipital Nerve Block for the Acute Treatment of Migraine Headache

A nurse filling a syringe
A nurse filling a syringe
Greater occipital nerve block may be an effective option for the acute management of migraine headache.

Greater occipital nerve block may be an effective option for the acute management of migraine headache, according to a study published in the Journal of the American Board of Family Medicine.

Researchers conducted a retrospective cohort study to assess the efficacy of greater occipital nerve block, which is frequently used to treat migraine headache.

The study included 592 patients who received at least 1 greater occipital nerve block procedure and attended at least 1 follow-up clinic visit between January 2009 and August 2014. To assess response to the procedure, researchers used the 11-point numeric pain rating scale (NPRS).

Patients were asked to rate the pain prior to receiving greater occipital nerve block and at a follow-up visit, which occurred between 1 and 4 weeks after the intervention. Intervention-associated improvements were defined as minimal (<30% NPRS point reduction), moderate (31%-50% NPRS point reduction), or significant (>50% NPRS point reduction).

Pain reduction following greater occipital nerve block was rated as moderate or significant by  82% of patients. Among patients who underwent 2 or more procedures, 74% rated the change in pain as significant, compared with 36% of those who underwent only 1 procedure (P =.001). Outcome did not vary significantly based on characteristics such as sex, age, or prior treatments.

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Researchers highlighted certain limitations, including lack of a control group as a result of the retrospective nature of the study, as well as an inability to perform subgroup analysis based on goal of treatment (acute pain management vs prophylactic treatment).

“Our findings are very positive in terms of the efficacy of [greater occipital nerve] block as a treatment option for migraine headache,” concluded the study authors.

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Allen SM, Mookadam F, Cha SS, Freeman JA, Starling AJ, Mookadam M. Greater occipital nerve block for acute treatment of migraine headache: A large retrospective cohort study. J Am Board Fam Med. 2018;31:211-218.