Serdar ÇATAV, FİLİZ ALKAYA SOLMAZ, Pakize KIRDEMİR

Migren başağrısında büyük oksipital sinir bloğu uygulama sonuçlarımız

Amaç: Bu çalışma, migren hastalarının tedavisinde büyük oksipital sinir bloğu (GON) etkinliğini değerlendirmek amacı ile yapıldı. Gereç ve Yöntem: Bu çalışmaya 2014-2015 yılları arasında migren tanısı almış 28 hasta dahil edildi. GON bloğu işlemi eksternal oksipital protuberans 2 cm laterali ve 2 cm inferiyoruna 1.5 ml %2 lidokain uygulanarak yapıldı. GON bloğu işlemi bilateral olarak 1 hafta ara ile 3 kez uygulandı. Hastanın VAS değerleri, atak sıklığı, atak süresi ve analjezik kullanım ihtiyacı işlem öncesinde değerlendirildi. İşlemden sonra 1. hafta, 1. ay, 3. ayda tekrar bu parametreler değerlendirildi. Bulgular: Hastaların yaş ortalaması 42.21±10.13. VAS skoru işlem öncesi 9.28±0.72 iken, işlemden sonra 1. haftada 2.96±2.16, 1. ayda 2.60±1.96, 3. ayda 1.75±1.37 idi. Atak sıklığını işlem öncesi 9.42±4.51 iken, 1. ay 5.42±3.30, 3. ay da 3.57±3.14 olarak değerlendirdik. Sonuç: Migren başağrısında GON bloğu 1.5 ml %2 lidokain ile güvenilir, basit ve efektif bir tedavi yöntemidir.

The results of greater occipital nerve block applied for migraine headache

Objectives: The aim of this study was to evaluate the efficacy of greater occipital nerve (GON) block in the treatment of migraine patients. Methods: This study included 28 patients diagnosed with migraine between 2014 and 2015. The GON block procedure was applied by administering 1.5 ml of 2% lidocaine 2 cm lateral and 2 cm inferior to the external occipital protuberance. The patients were evaluated in respect of VAS scores, attack frequency, attack duration and the need for analgesia before the procedure. These parameters were evaluated again at 1 week, 1 month and 3 months after the procedure. Results: The mean age of the patients was 42.21±10.13 years. The mean VAS score was 9.28±0.72 before the procedure and 2.96±2.16 at 1 week, 2.60±1.96 at 1 month and 1.75±1.37 at 3 months. The frequency of attacks was 9.42±4.51 before the procedure and, 5.42±3.30 at 1 month and 3.57±3.14 at 3 months. Conclusion: GON block with 1.5 ml of 2% lidocaine is a safe, simple and effective treatment method for migraine headache.

PDF

___

Goldstein J, Hoffman HD, Armellino JJ, Battikha JP, Ha- melsky SW, Couch J, et al. Treatment of severe, disabling migraine attacks in an over-the-counter population of migraine sufferers: results from three randomized, place- bo-controlled studies of the combination of acetaminop- hen, aspirin, and caffeine. Cephalalgia 1999;19(7):684-91.
Kalra AA, Elliott D. Acute migraine: Current treatment and emerging therapies. Ther Clin Risk Manag 2007;3(3):449- 59.
Estemalik E, Tepper S. Preventive treatment in migrai- ne and the new US guidelines. Neuropsychiatr Dis Treat 2013;9:709-20.
Cutrer FM, Charles A. The neurogenic basis of migraine. He- adache 2008;48(9):1411-4.
Kelley NE, Tepper DE. Rescue therapy for acute migraine, part 3: opioids, NSAIDs, steroids, and post-discharge medi- cations. Headache 2012;52(3):467-82.
Kerr FW, Olafson RA. Trigeminal and cervical volleys. Con- vergence on single units in the spinal gray at C-1 and C-2. Arch Neurol 1961;5:171-8.
Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalal- gia 2013;33(9):629-808.
Procacci P. Comments on G. Bovim and T. Sand, Pain, 51 (1992) 43-48. Pain 1993;53(1):111-2.
Okmen K, Dagistan Y, Dagistan E, Kaplan N, Cancan E. Efficacy of the greater occipital nerve block in recurrent migraine type headaches. Neurol Neurochir Pol 2016;50(3):151-4.
Lantéri-Minet M, Duru G, Mudge M, Cottrell S. Quality of life impairment, disability and economic burden associa- ted with chronic daily headache, focusing on chronic mig- raine with or without medication overuse: a systematic review. Cephalalgia 2011;31(7):837-50.
Hadden S. Neuralgic headache and facial pain. Arch Neurol Psychiatr 1940;43:405-8.
Ambrosini A, Vandenheede M, Rossi P, Aloj F, Sauli E, Pierelli F, et al. Suboccipital injection with a mixture of rapid- and long-acting steroids in cluster headache: a double-blind placebo-controlled study. Pain 2005;118(1-2):92-6.
Soto E, Bobr V, Bax JA. Interventional techniques for hea- daches. Techniques in Regional Anesthesia & Pain Mana- gament 2012;16:30-40
Afridi SK, Shields KG, Bhola R, Goadsby PJ. Greater occi- pital nerve injection in primary headache syndromes-- prolonged effects from a single injection. Pain 2006;122(1- 2):126-9.
Shields KG, Levy MJ, Goadsby PJ. Alopecia and cutaneous atrophy after greater occipital nerve infiltration with corti- costeroid. Neurology 2004;63(11):2193-4.
Lambru G, Lagrata S, Matharu MS. Cutaneous atrophy and alopecia after greater occipital nerve injection using triam- cinolone. Headache 2012;52(10):1596-9.
Kashipazha D, Nakhostin-Mortazavi A, Mohammadia- ninejad SE, Bahadoram M1, Zandifar S, Tarahomi S. Pre- ventive effect of greater occipital nerve block on severity and frequency of migraine headache. Glob J Health Sci 2014;6(6):209-13.
Takmaz SA, Inan N, Uçler S, Yazar MA, Inan L, Başar H. Grea- ter occipital nevre block in migraine headache: preliminary results of 10 patients. Agri 2008;20(1):47-50.
Dilli E, Halker R, Vargas B, Hentz J, Radam T, Rogers R, et al. Occipital nerve block for the short-term preventive treat- ment of migraine: A randomized, double-blinded, place- bo-controlled study. Cephalalgia 2015;35(11):959-68.