Efficacy of greater occipital nerve block treatment for migraine and potential impact of patient positioning during procedure: results of randomised controlled trial

Vanderpol, Jitka, Kennedy, Gina, Ahmed, Fayyaz and Jonker, Leon ORCID: https://orcid.org/0000-0001-5867-4663 (2024) Efficacy of greater occipital nerve block treatment for migraine and potential impact of patient positioning during procedure: results of randomised controlled trial. Clinical Neurology and Neurosurgery, 239 . p. 108210.

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Abstract

Purpose: Assess the efficacy, and potential impact of patient positioning for 10 minutes immediately post-procedure, of greater occipital nerve (GON) block for treatment of migraine.

Methods: Prospective multicentre non-blinded randomised controlled trial, randomisation and treatment of 60 neurology clinic patients with poorly controlled migraine. Outcomes measured with Headache Impact Test-6 (HIT-6), modified MIgraine Disability Assessment Scale (M-MIDAS), and RELIEF scores.

Results: Patient positioning did not lead to significant difference in RELIEF score (34% vs 11%, p-value 0.10, Chi-squared test) at day 90. When considered in a multiple regression analysis, the sitting position outperformed supine position significantly (p-value 0.04). However, no significant difference in HIT-6 score between the supine (n = 27) and sitting position groups (n = 33) was detected at baseline (p-value 0.76), day 30 (p-value 0.69) or day 90 (p-value 0.54, Mann-Whitney U-test). The HIT-6 score significantly improved post-GON block, from median 67 (baseline pre-GON) to 59 (day 30) and 62 (day 90) for the supine group and a score of 66, 61 to 62 for the sitting group (all p-value ≤ 0.001, intra-group comparison using Wilcoxon test); M-MIDAS achieved similar outcomes. Overall, a significant minimal clinically important improvement was obtained with GON block, and the GON injections were deemed very tolerable by patients (median score of 2 on 10 cm pain scale).

Conclusion: Regardless of patient positioning, GON block is an effective and near-painless procedure for migraine symptom control. Unlike earlier published observational study data, this trial concludes that a sitting patient position immediately post-GON is preferred.

Item Type:	Article
Journal / Publication Title:	Clinical Neurology and Neurosurgery
Publisher:	Elsevier
ISSN:	1872-6968
Departments:	Institute of Health > Medical Sciences
Additional Information:	This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
Depositing User:	Anna Lupton
Date Deposited:	05 Mar 2024 12:40
Last Modified:	11 Mar 2024 20:45
URI:	https://insight.cumbria.ac.uk/id/eprint/7568

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