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Acta Neurol Scand. 2017 Apr;135(4):426-433. doi: 10.1111/ane.12692. Epub 2016 Sep 26.

Greater occipital nerve block in the treatment of triptan-overuse headache: A randomized comparative study.

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Department of Neurology, Ankara Mevki Military Hospital, Ankara, Turkey.
Department of Neurology, Liv Hospital, Ankara, Turkey.
Department of Medical Biochemistry, Gulhane Military Medical Academy, Haydarpasa Training Hospital, Istanbul, Turkey.
Department of Neurology, Mersin University School of Medicine, Mersin, Turkey.



This study aims to investigate the efficiency of a single and repeated greater occipital nerve (GON) block using lidocaine in the treatment of triptan-overuse headache (TOH), whose importance has increased lately.


In the study, 105 consecutive subjects diagnosed with TOH were evaluated. The subjects were randomized into three groups. In Group 1 (n=35), only triptan was abruptly withdrawn. In Group 2 (n=35), triptan was abruptly withdrawn and single GON block was performed. In Group 3 (n=35), triptan was abruptly withdrawn and three-stage GON block was performed. All patients were injected bilaterally with a total amount of 5 cc 1% lidocaine in each stage. During follow-up, the number of headache days per month, the severity of pain (VAS), the number of triptans used, and hsCRP and IL-6 levels were recorded three times; in the pretreatment period, in the second month post-treatment, and in the fourth month post-treatment. They were then compared.


There was a statistically significant difference in the post-treatment fourth month in comparison with the pretreatment period in Group 3 (P<.05). Compared to Group 1, the number of headache days, VAS, and decrease in triptan need in Group 3 was statistically significant compared to Group 2 (P<.05). Compared to pretreatment, in the fourth month post-treatment, both hsCRP and IL-6 levels were lower only in Group 3 (P<.05).


We are of the opinion that repeated GON block in addition to the discontinuation of medication has significant efficacy for TOH cases.


greater occipital nerve; medication overuse headache; migraine; occipital nerve block; triptan-overuse headache

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