Bilateral Greater Occipital Nerve Blocks (GONB) With Bupivacaine for Acute Migraine Patients Refractory to Standard Emergency Department Treatment With Metoclopramide

Primary tabs

SCIENCE
Bilateral Greater Occipital Nerve Blocks (GONB) With Bupivacaine for Acute Migraine Patients Refractory to Standard Emergency Department Treatment With Metoclopramide
Key Take-Away: 

Friedman BW et al. elucidated that Greater Occipital Nerve Blocks (GONB) might be an effective treatment for ED patients with an acute migraine, suffering from a moderate or a severe headache after the application of intravenous metoclopramide. But, this investigation was discontinued before achieving a priori sample size due to the slow enrollment.

Introduction:

It is believed that Greater occipital nerve block (GONB) is an effective treatment for acute migraine, but there has been no randomized efficacy data published for the same. It was hypothesized that bilateral GONB with bupivacaine may lead to greater rates of headache freedom than a sham injection among emergency department (ED) patients who described the persistence of a moderate or severe headache despite standard treatment with i.v. Metoclopramide.

 

Methods:

This randomized clinical trial was conducted in 2 urban EDs. The patients with an acute migraine who described the persistence of a tolerable or severe headache for at least an hour or more after treatment with i.v. metoclopramide 10mg were randomized to bilateral GONB with a total of 0.5% bupivacaine 6 mL or bilateral intradermal scalp injection with a total of 0.5% bupivacaine 1 mL. Primary outcome depicted complete headache freedom for 30 minutes after the injection. A key secondary outcome was sustained headache relief, known as achieving a headache level of mild or none in the ED and also maintaining a level of mild or none without the use of further headache medication for 48 hours.

 

Results:

A total of 76 patients were screened for participation and 28 were registered, out of which 15 received sham injection and 13 received GONB 1 mL for 31 months. This study was ceased before having a priori sample size due to slow enrollment. Headache freedom at 30 minutes - was produced by 0/15 (0%) of patients in the sham arm and 4/13 (31%) of patients in the GONB arm (95%CI for a difference of 31%: 6, 56%, P = 0.035) in the primary outcome. Sustained headache relief for 48 hours, was reported by 0/15 sham patients (0%) and 3/13 (23%) GONB patients (95% CI for the difference of 23%: 0, 46%, P = 0.087) was observed in the secondary outcome. The reported side effects did not vary substantially between the groups.

 

Conclusion:

GONB treatment may be efficacious for ED patients with an acute migraine who continuously suffered from moderate or severe headache after administration of intravenous metoclopramide. But, this study was stopped before achieving a priori sample size.

Source

Headache

Link:

https://www.ncbi.nlm.nih.gov/pubmed/30144034

Original title of article:

A Randomized, Sham-Controlled Trial of Bilateral Greater Occipital Nerve Blocks With Bupivacaine for Acute Migraine Patients Refractory to Standard Emergency Department Treatment With Metoclopramide

Authors:

Friedman BW et al.

Therapeutic, Bupivacaine, Metoclopramide, Migraine, Headache, Head, Acute, Anesthetic, Prokinetic agent, Randomized clinical Trial, Symptomatic Therapy, Efficacy, Intravenous
Log in or register to post comments