Ultrasound-Guided Combined Greater Occipital Nerve Block at the C2 Level with Trapezius Trigger Point Injection and Supraorbital-Supratrochlear Nerve Block: More Effective on Allodynia and Disability in Chronic Migraine

Suna Aşkın Turan; Şenay Aydın; Melih G Gözükara; Murat Çabalar

doi:10.4103/aian.aian_677_23

Ultrasound-Guided Combined Greater Occipital Nerve Block at the C2 Level with Trapezius Trigger Point Injection and Supraorbital-Supratrochlear Nerve Block: More Effective on Allodynia and Disability in Chronic Migraine

Ann Indian Acad Neurol. 2023 Nov-Dec;26(6):943-951. doi: 10.4103/aian.aian_677_23. Epub 2023 Dec 15.

Authors

Suna Aşkın Turan¹, Şenay Aydın², Melih G Gözükara³, Murat Çabalar⁴

Affiliations

¹ Department of Pain, Basaksehir Cam and Sakura City Hospital, University of Health Sciences, İstanbul.
² Department of Neurology, Yedikule Chest Disease and Surgery Training and Research Hospital, University of Health Sciences, Istanbul.
³ Public Health Department, School of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkiye.
⁴ Department of Neurology, Basaksehir Cam and Sakura City Hospital, University of Health Sciences, İstanbul.

Abstract

Background: Chronic migraine (CM) patients with cutaneous allodynia (CA) show a poor response to treatment. Long-term studies have yet to be conducted to demonstrate the efficacy of blocks on CA. This study evaluated the improvement in allodynia and disability in CM treated with ultrasound (US)-guided blocks.

Methods: In this prospective, non-randomized comparative study, 60 CM patients with CA were evaluated for the clinical effectiveness of the therapy using the numeric rating scale (NRS), headache impact test-6 (HIT-6), brush allodynia test, and allodynia symptom checklist (ASC-12). At the first visit, tenderness in the nerve or trapezius muscle was confirmed in the intervention group. US-guided greater occipital nerve block (GONB), GONB, and trapezius muscle injection (TPI), or GONB, TPI, and peripheral trigeminal nerve block (PTNB), respectively, were performed four times once a week for a month. Initial and third-month assessments were performed.

Results: The ASC-12 scores decreased in the GONB+TPI+PTNB and GONB groups more than the GONB+TPI group (mean rank, respectively, 26.86, 27.40, 38.39; P = 0.018). The decrease in HIT-6 scores was greater in the GONB+TPI+PTNB group than in the GONB group (mean rank, respectively, 21.98, 39.95, P < 0.017) in the first month. In the third month, the GONB+TPI+PTNB group scored HIT-6 significantly lower than GONB and GONB+TPI (mean rank: 18.84, 38.73, 35.61; P < 0.001).

Conclusions: GONB+TPI+PTNB was more successful in alleviating allodynia and disability.

Keywords: Allodynia; migraine; nerve block; proximal GONB; trapezius muscle.