Single occipital nerve blockade efficacy and safety in episodic and chronic cluster headache
Cluster headaches occur as attacks of severe, one-sided headaches. Typically, a number of attacks occur over several weeks - about (cluster) of attacks. The headaches then usually go for weeks, months or years until a next cluster of headaches develops. Treatment options for cluster headache (CH) include acute, transitional and prophylactic strategies. A study was conducted to assess the efficacy and safety of a single occipital nerve block (ONB) in patients with episodic (eCH) and chronic CH (cCH).
In the conducted observational study, 101 CH were treated with a single ONB using triamcinolone 10mg and bupivacaine. Attack frequency, pain intensity and side effects were assessed at days 1 and 7 after ONB and thereafter weekly for 60 days until recurrence of attacks.
After analysis, baseline mean daily attack frequency was 2.9 ± 2.5 (eCH) and 3.3 ± 2.9 (cCH), which was reduced to 0.7 ± 1.2 (eCH) and 1.1 ± 1.4 (cCH) after one day (p = 0.08 for group difference) and to 1.1 ± 1.6 (eCH) and 1.9 ± 2.3 (cCH) after seven days (p = 0.01 for group difference). In patients with eCH pain-free period lasted longer compared to cCH (p= 0.004). There was no association between the presence of local anesthesia and treatment response (p= 0.88). No serious adverse events occurred. From the observational study, it was concluded that occipital nerve block is an easy, safe and effective transitional treatment option of insufficient response of CH to treatment both in patients with eCH and cCH. Patients with eCH have proven to be a better and more sustainable treatment response.