Role of greater occipital nerve blocks and trigger point injections for patients with dizziness and headache

Neurologist. 2011 Nov;17(6):312-7. doi: 10.1097/NRL.0b013e318234e966.

Abstract

Background: The trigeminocervical system is integral in cervicogenic headache. Cervicogenic headache frequently coexists with complaints of dizziness, tinnitus, nausea, imbalance, hearing complaints, and ear/eye pain. Controversy exists as to whether this constellation of symptoms may be cervically mediated.

Objectives: To determine whether a wider spectrum of cervically mediated symptoms exist, and to investigate a potential role of greater occipital nerve blocks (GON) and trigger point injections (TPI) in these patients.

Methods: Retrospective review of GON/TPI performed in a tertiary otoneurology/headache clinic from May 2006 to March 2007 for suspected cervically mediated symptoms. Data included chief complaint, secondary symptoms, response to injection, pre-GON/TPI posterior vertex sensation changes to pinprick, cervical spine examination, and response to vibration of cervical and suboccipital musculature.

Results: Total number of 147 patients were included. Chief complaints in decreasing frequency: dizziness (93%), tinnitus (4%), headache (3%), and ear discomfort (0.7%). Overall symptoms in decreasing frequency: dizziness (97%), headache (88%), neck pain (63%), tinnitus (23%), and ear discomfort (22%). Improvements after GON/TPI: neck range of motion (71%), headache (57%), neck pain (52%), ear discomfort (47%), dizziness (46%), and tinnitus (30%). Dizziness responders had neck position asymmetries (84%), reproducible dizziness by cervical and suboccipital musculature vibration (75%), and preinjection posterior vertex sensory changes (60%).

Conclusions: A wider spectrum of cervically mediated symptoms may exist by influence of trigeminocervical and vestibular circuitry through cervical afferent neuromodulation. Certain examination findings may help to predict benefit from GON/TPI.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anesthetics, Local / therapeutic use*
  • Animals
  • Betamethasone / analogs & derivatives
  • Betamethasone / therapeutic use
  • Bupivacaine / therapeutic use
  • Child
  • Dizziness / drug therapy*
  • Dizziness / physiopathology
  • Female
  • Glucocorticoids / therapeutic use
  • Humans
  • Injections
  • Male
  • Middle Aged
  • Nerve Block / methods*
  • Post-Traumatic Headache / drug therapy*
  • Post-Traumatic Headache / physiopathology
  • Reflex
  • Retrospective Studies
  • Trigger Points / physiology*
  • Young Adult

Substances

  • Anesthetics, Local
  • Glucocorticoids
  • betamethasone sodium phosphate
  • Betamethasone
  • Bupivacaine