Treating Migraine with Greater Occipital Nerve Blocks

November 11, 2009 by dean · Leave a Comment 

A skilled examination of the neck need not be an after thought

A skilled examination of the neck need not be an after thought

Whilst the primary of this study was to assess the effectiveness of greater occipital nerve blocks on ‘medication overuse headache’, it also demonstrated that of 108 nerve blocks, 78% of headache sufferers responded with an average 83% decrease in severity which lasted almost 7 weeks.

The greatest effect was in those patients whose headaches developed after being concussed (100%), then 89% for episodic migraine and less effect on those with chronic migraine (61%).

Once again more evidence that examination of the upper neck in headache and migraine sufferers should not be an ‘after-thought’ – it should be routine – it borders on irresponsibility if an examination of the neck is not performed once all other investigations have been carried out ….

Cheers

Dean

(Tobin JA, Flitman SS. Nerve Blocks: Effect of Symptomatic Medication Overuse and Headache Type on Failure Rate. Headache 2009;49(10);1479-1485)

© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.

Treating Headache and Migraine with Greater Occipital Nerve Blocks

November 10, 2009 by dean · Leave a Comment 

Blocking the greater occipital nerve (which prevents information from the neck influencing the brainstem) continues to attract attention.

The authors after reviewing 21 pieces of research, whilst recommending that further research needs to be done, concluded that blocking or anaesthetising the greater occipital nerve is a worthwhile treatment approach for cervicogenic (neck-related) headache, cluster headache and migraine.

The positive results obtained through this procedure suggest that neck disorders are involved in the mechanisms of these headache conditions …. but blocks are not necessary … a skilled examination and treatment of relevant neck disorders can achieve the same result, without injections!

Cheers

Dean

(Tobin J, Flitman S.Occipital Nerve Blocks: When and What to Inject? Headache 2009;49:1521 - 1533)

© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.

Cervicogenic Headache is Rare – You Have Got to be Kidding (?)

October 7, 2009 by dean · Leave a Comment 

In a study coming out of Norway the incidence of cervicogenic (neck) headache was found to be rare – only 0.17% of the population.

It is interesting to note that the diagnosis was made based only on the features of headache. It is widely accepted that features of headache alone are not sensitive enough to differentiate cervicogenic headache from migraine and from tension headache.

To diagnose cervicogenic headache, a thorough and skilled examination of the upper neck needs to be performed for temporary reproduction (and resolution) of familiar headache.

A physical examination was performed on only those headache sufferers selected on the basis of their headache features (and did include the above!). If it had it would have confirmed cervicogenic headache. However this is not the point, the physical examination was performed on only a select few!

Similarly, greater occipital nerve (GON) blocks blocks were performed only on those selected from their headache features – the blocks were effective in over 90% – I am not surprised. As with the physical examination, the blocks needed to be performed before a diagnosis of cervicogenic headache was made.

I have written before of the numerous studies demonstrating that headaches with a diagnosis of migraine are relieved by blocking the GON (greater occipital nerve) – who knows how many of the headache sufferers were excluded based on features and who had cervicogenic headache (?)

Previous research has shown that cervicogenic (neck) headache is as common as migraine.

Cheers

Dean

(Knackstedt H. Cervicogenic headache in the general population. the Akershus study of chronic headache. Cephalalgia 2009;29 (Suppl. 1):1–166

Nilsson N. The prevalence of cervicogenic headache in a random population sample of 20-59 year olds. Spine 1995;20:1884-1888

Rozen T. Cessation of hemiplegic migraine auras with greater occipital nerve blockade. Headache 2007;47:917-928

Takmaz, S. et al Greater occipital nerve block in migraine headache: Preliminary results of 10 patients. Agri 2008 Jan;20(1):47-50

Yi X et al Cervicogenic headache in patients with presumed migraine: missed diagnosis or misdiagnosis? J Pain. 2005 Oct;6(10):700-3

Young WB, Marmura M, Ashkenazi A, Evans RW. Expert opinion: Greater occipital nerve and other anesthetic injections for primary headache disorders. Headache. 2008;48:1122-1125

Young et al. The first 5 minutes after greater occipital nerve block. Headache 2008;48:1126-1139)

© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.

Hemicrania Continua and Cervicogenic (neck-related) Headache – Are They The Same Condition?

August 31, 2009 by dean · Leave a Comment 

Interesting to note a case study reporting that the head pain of a patient suffering hemicrania continua was temporarily reproduced and resolved by neck movements and later by blocking or injecting the greater occipital nerve. These two features are key diagnostic signs of cervicogenic or neck related headache and indeed this respected researcher concludes this.

Cheers

Dean

(Rothbart P. Unilateral Headache with Features of Hemicrania Continua and Cervicogenic Headache – A Case Report. Headache 1992;(32)9;459-60)

© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.

Greater Occipital Nerve Blocks Relieve Migraine and Cluster Headache

August 11, 2009 by dean · Leave a Comment 

Another example of migraine headache being relieved within 30 seconds after injection of the greater occipital nerve.

Need I say more ….. just part of the overwhelming evidence for cervicogenic involvement in migraine …. but there is more!

Blocking the greater occipital nerve in 14 cluster headache patients substantially decreased their symptoms with the researchers suggesting that this procedure is a significant treatment option i.e. eliminating information from structures of the upper neck leads to relief from cluster headache …..

Cheers

Dean

(Young WB et al. Greater Occipital Nerve and Other Anesthetic Injections for Primary Headache Disorders. Headache 2008;48:112-1125 : Peres MF. et al Greater occipital nerve blockade for cluster headache. Cephalalgia 2002;22:520-522)

© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.

Migraine Aura Eliminated by Blocking the Greater Occipital Nerve

August 10, 2009 by dean · Leave a Comment 

Neck disorders can be significant in the headache and migraine process

Neck disorders can be significant in the headache and migraine process

Not only can the pain of migraine be relieved by injecting the greater occipital nerve but also the aura.

In two patients with hemiplegic migraine their aura symptoms were completely stopped within 5 minutes and without the usual following headache.

Interestingly this is very similar to my clinical experience. I have had the opportunity to treat two patients within 5 minutes of an (visual) aura starting. Within 5 minutes of mobilising their upper cervical spine, their auras had stopped and in both patients, the headache that usually follows did not happen.

This provides further support that neck disorders can be significant in the headache and migraine process.

Cheers

Dean

(Rozen T. Cessation of Hemiplegic Migraine Auras With Greater Occipital Nerve Blockade. Headache 2007;47:917-919)

© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.

Orgasmic Headache and Your Neck!

August 5, 2009 by dean · Leave a Comment 

Uh, uh …. the greater occipital nerve is the culprit!

Injecting the greater occipital has been shown to relieve orgasmic headache. This case study supports my clinical experience which is that orgasmic headache can be treated successfully when relevant neck disorders are identified and treated.

Cheers

Dean

(Selekler M et al. Orgasmic Headache Responsive to Greater Occipital Nerve Blockade. Headache 2008 Sep;49(1):130-131)

© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.

What Does Blocking The Greater Occipital Nerve Do?

August 3, 2009 by dean · Leave a Comment 

I have been mentioning the research which shows that by injecting and anaesthetising the greater occipital nerve the migraine process can be halted … so what does this do?

Anaesthetising the greater occipital nerve prevents information from (neck) structures supplied by the nerve from entering into the spinal cord (and the brainstem). The effect of this on migraine and headache symptoms suggests that this information being carried by the nerve was sensitising the brainstem and that by preventing it from reaching the brainstem, the brainstem is no longer sensitised.

This then is considered a diagnostic tool to confirm cervicogenic (neck) disorders in headache and migraine.

Cheers

Dean

(Akin Takmaz et al. Greater occipital nerve block in migraine headache: Preliminary results of 10 patients. Agri. 2008 Jan;20(1):47-50

Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders, 2nd edn. Cephalalgia 2004; 24(suppl.1):1-151

Peres MF. et al Greater occipital nerve blockade for cluster headache. Cephalalgia 2002;22:520-522

Rozen T. Cessation of hemiplegic migraine auras with greater occipital nerve blockade. Headache 2007;47:917-928

Sjaastad O, Fredricksen TA, Pfaffenrath V. Cervicogenic headache: diagnostic criteria. Headache 1998; 38:442-5

Tobin J,Stephen Flitman S. Nerve Blocks: When and What to Inject? Headache 2009

Yi X et al Cervicogenic headache in patients with presumed migraine: missed diagnosis or misdiagnosis? J Pain. 2005 Oct;6(10):700-3

Young et al Greater occipital nerve and other anesthetic injections for primary headache disorders. Headache 2008;48:1122-1125

Young et al. The first 5 minutes after greater occipital nerve block. Headache 2008;48:1126-1139)

© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.

Is Your Migraine From Your Neck?

August 1, 2009 by dean · Leave a Comment 

Many clinicians have demonstrated that blocking or ‘numbing’ of the greater occipital nerve provides substantial relief from ‘migraine’ in many patients. Researchers have confirmed this experience. Whilst this approach is not available to everyone it does confirm that cervicogenic disorders can be responsible for ‘migraine‘.

OK so a neck disorder has been confirmed – what happens once the anaesthetic has worn off though? A skilled examination of the neck and appropriate treatment often means that ongoing injections will not be necessary (and anyway the number you can have is limited).

However it is not necessary for a nerve block in the first place – an assessment by competent clinicians can confirm or eliminate a neck disorder as the source of symptoms.

Cheers

Dean

(Akin Takmaz, S. et al Greater occipital nerve block in migraine headache: Preliminary results of 10 patients. Agri 2008 Jan;20(1):47-50

Jull G, Bogduk N, Marsland A. The accuracy of manual diagnosis for cervical zygapophyseal joint pain syndromes. Med J Aust. 1988 Mar 7;148(5):233-6

Rozen T. Cessation of hemiplegic migraine auras with greater occipital nerve blockade. Headache 2007;47:917-928

Takmaz, S. et al Greater occipital nerve block in migraine headache: Preliminary results of 10 patients. Agri 2008 Jan;20(1):47-50

Young et al Greater occipital nerve and other anesthetic injections for primary headache disorders. Headache 2008;48:1122-1125

Young et al. The first 5 minutes after greater occipital nerve block. Headache 2008;48:1126-1139

Yi X et al Cervicogenic headache in patients with presumed migraine: missed diagnosis or misdiagnosis? J Pain. 2005 Oct;6(10):700-3)

© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.

Cervicogenic (neck) Headache and Migraine or the Same Condition?

July 24, 2009 by dean · Leave a Comment 

Why is it that if treatment of the neck provides relief that it is assumed that cervicogenic (neck) co-exists with migraine or that it is a misdiagnosed migraine? Why can’t it be that cervicogenic factors are instrumental in the migraine process?

Clearly when patients with ‘migraine’ who have not responded to recognised migraine treatments, achieve substantial pain relief to numbing of the greater occipital nerve, there can be only one conclusion …noxious (abnormal) information from the neck is responsible for the migraine process.

Cheers

Dean

(Yi, X. et al Cervicogenic headache in patients with presumed migraine: missed diagnosis or mis diagnosis? J Pain 2005 Oct;6(10):700-3)

© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.