Greater occipital nerve block for the acute treatment of prolonged or persistent migraine aura

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Greater occipital nerve block for the acute treatment of prolonged or persistent migraine aura
Key Take-Away: 

Migraine encompass numerous encephalic structures in its pathophysiology with the trigeminal nerve (TN) type being one of the crucial ones. The greater occipital nerve block (GON) explained in this study is a simple, safe and effective technique for migraine aura treatment.

Presently, there is no evidence to guide the acute treatment of migraine aura.

ABSTRACT: 
Background: 

Presently, there is no evidence to guide the acute treatment of migraine aura.

We aimed to describe the effect of greater occipital nerve (GON) anesthetic block as a symptomatic treatment for long-lasting (prolonged or persistent) migraine aura.

Methods: 

Patients who presented with migraine aura lasting > 2 hours were consecutively recruited during one year at the Headache Unit and the Emergency Department of a tertiary hospital.

All patients underwent a bilateral GON block with bupivacaine 0.5%. Patients were followed up for 24 hours.

Results: 

A total of 22 auras were treated in 18 patients. Auras consisted of visual (n = 13), visual and sensory (n = 4) or sensory symptoms alone (n = 5). Eleven episodes met diagnostic criteria for persistent aura (>1 week) without infarction.

The response was complete without early recurrence in 11 cases (50%), complete with recurrence in < 24 hours in two cases (9.1%), and partial with ≥ 50% improvement in six cases (27.3%). Complete responses without recurrence were more common in cases with prolonged auras lasting < 1 week than in those with persistent auras (72.7% vs. 27.3%; p = 0.033).

Conclusion: 

GON block could be an effective symptomatic treatment for prolonged or persistent migraine aura. Randomised controlled trials are still required to confirm these results.

Cephalalgia. 2016 Jun 10
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