Effects of greater occipital nerve block with local anesthetic and triamcinolone for treatment of medication overuse headache: an open-label, parallel, randomized, controlled clinical trial

• Published in: Neurological sciences 2022, Vol.43 (1), p.549-557
• Main Authors: Arab, Arman, Khoshbin, Masoud, Karimi, Elham, Saberian, Ghazal, Saadatnia, Mohammad, Khorvash, Fariborz
• Format: Article
• Language: English
• Subjects: Analgesics; Anesthetics, Local; Clinical trials; Detoxification; Headache; Headache - chemically induced; Headache - drug therapy; Headache Disorders, Secondary - drug therapy; Headaches; Humans; Iran; Lidocaine; Local anesthesia; Medicine; Medicine & Public Health; Migraine; Nerve Block; Neurology; Neuroradiology; Neurosciences; Neurosurgery; Original Article; Patients; Promethazine; Psychiatry; Treatment Outcome; Triamcinolone
• ISSN: 1590-1874; 1590-3478
• DOI: 10.1007/s10072-021-05295-y

Aim There is a paucity of evidence and consensus on exactly how to carry out the detoxification process. To examine the effect of a greater occipital nerve block (GONB) in the detoxification process, we conducted an open-label, parallel, randomized, controlled clinical trial. Materials and methods In order to conduct this study, 54 medication-overuse headache (MOH) patients were recruited and allocated randomly to group A ( n = 27) or B ( n = 27). In both groups, patients underwent detoxification processes without any acute migraine medication or analgesics. During the run-in period, all patients in both groups received the same education, managed by a neurologist and nutritionist. All patients were offered maximally 300 mL of promethazine syrup (5 mg/5 mL) to be taken 10 mg every 8 h during the first 10 days of the study. A 2-mL syringe containing 1 mL of lidocaine 2% and 1 mL of triamcinolone 40 mg/mL was prepared for each patient of group A for conducting GONB. Characteristics of headache attacks, including headache severity, frequency, and duration, were assessed at baseline and after 3 months of intervention. Results Twenty-six patients in group A (96.3%) and twenty-three in group B (85.2%) completed detoxification, and were thus cured of MOH ( P = 0.351). The present study revealed that GONB with local anesthetic and triamcinolone significantly improved the characteristics of headache, including frequency (− 13.66 in group A and − 7.55 in group B), duration (− 7.92 in group A and − 5.88 in group B), and severity (− 3.44 in group A vs. − 1.33 in group B) in group A compared to control (all P value < 0.05). Conclusions Although both detoxification programs were effective, detoxification with GONB resulted in better outcomes. Trial registration Iranian Registry of Clinical Trials (registration number; IRCT20150906023922N2)