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Headache. 2019 Jan;59(1):56-62. doi: 10.1111/head.13394. Epub 2018 Aug 24.

High-Volume Anesthetic Suboccipital Nerve Blocks for Treatment Refractory Chronic Cluster Headache With Long-Term Efficacy Data: An Observational Case Series Study.

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1
Mayo Clinic Florida, Jacksonville, FL, USA.

Abstract

OBJECTIVE:

To determine the efficacy of high-volume anesthetic suboccipital nerve blocks (HVSON) for chronic cluster headache (CCH) and to define consistency of response over long-term use.

BACKGROUND:

There are studies showing efficacy of greater occipital and suboccipital nerve block injections for CCH and also their possible use as a preventive treatment modality. There are scant data about the long-term efficacy of repetitive greater occipital and suboccipital nerve injections in CCH. HVSON has not been studied for CH.

METHODS:

This was an open label, observational, case series study. Patients with CCH seen at a dedicated headache clinic over a 7-year time period and injected on at least 2 separate occasions were used for analysis. All were deemed medicinal treatment refractory. HVSON consisted of 9 mL 1% lidocaine and 1 mL triamcinolone 40 mg/mL injected on the side of CH.

RESULTS:

Ten CCH patients were retrospectively studied. Range of mean average response to HVSON (all patients had complete pain freedom) was 1.5-31 weeks (longest: 44 weeks in 2 patients). Only one patient did not respond; 2 patients had 1.5-2 weeks of response; the remainder had at least 4 weeks of response. The mean average duration of effect was 10.3 weeks in the responders. Five patients were injected serially for 2-4 years (30x, 17x, 15x, 10x and 3x, respectively) with a consistent response of 6 weeks, 4 weeks, 12 weeks, 4 weeks, and 31 weeks, respectively, after each injection. Response duration was very reliable per individual patient. All 5 patients felt HVSON was effective as a preventive treatment. Smoking history did not appear to alter treatment response (8/10 were chronic current smokers and 7/8 responded to HVSON). The one patient who received the most injections developed avascular necrosis of the hip; the remainder of the subjects had no adverse events.

CONCLUSION:

HVSON from this open label study appears to be effective in the preventive treatment of medicinal refractory CCH and shows consistent response over long-term use with high rates of pain freedom.

KEYWORDS:

cluster headache; greater occipital nerve; preventive therapy; suboccipital nerve block

PMID:
30144049
DOI:
10.1111/head.13394

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