Department of Neurology

Department of Neurology Faculty Papers

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TITLE:
Greater occipital nerve block using local anesthetics alone or with triamcinolone for transformed migraine: A randomized comparative study

AUTHOR(S):
Avi Ashkenazi, Thomas Jefferson University
Rebecca Matrow, Thomas Jefferson University
James W. Shaw, University of Illinois at Chicago
Muhammad A. Abbas, Thomas Jefferson University
Stephen D. Silberstein, Thomas Jefferson University

DOCUMENT TYPE: Article

This article has been peer reviewed. It is the version posted online prior to print by the Journal of Neurology, Neurosurgery and Psychiaty in August 2007. The JNNP version is available at http://dx.doi.org/10.1136/jnnp.2007.124420 Copyright (c) by the authors.

ABSTRACT:

Objective: To determine whether adding triamcinolone to local anesthetics increased the efficacy of GONB and trigger point injections (TPIs) for transformed migraine (TM).

Methods: TM patients were randomized to receive GONB and TPIs using lidocaine 2% and bupivacaine 0.5% + either saline or triamcinolone 40 mg. We assessed the severity of headache and associated symptoms before and 20 minutes after injection. Patients documented headache and associated symptoms severity for 4 weeks after injections. Changes in symptom severity were compared between the two groups.

Results: Thirty seven patients were included. Twenty minutes after injection, mean headache severity decreased by 3.2 points in group A (p<0.01) and by 3.1 points in group B (p<0.01). Mean neck pain severity decreased by 1.5 points in group A (p<0.01) and by 1.7 points in group B (p<0.01). Mean duration of being headache free was 2.7±3.8 days in group A and 1.0±1.1 days in group B (p=0.67). None of the outcome measures differed significantly between the two groups. Both treatments were well-tolerated.

Conclusions: Adding triamcinolone to local anesthetics when performing GONB and TPIs was not associated with improved outcome in this sample of transformed migraine patients.