Greater Occipital Nerve Injection

Paul Ballinger

1. Cluster headache-13 active steroid,10 saline.11 patients (85%) became attack free in 1st week and 8 remained attack free at 4 weeks

Ambrosini A, Vandenheede M, Rossi P, et al.Pain. 2005;118:92-96

2.CEH-24 in treatment arm 23 in placebo. Active group showed a 50% reduction in pain at 2 weeks.

Naja ZM, El-Rajab M, Al-Tannir MA etal. Pain Pract.2006;6:89-95.

160mg depo medrone plus 3ml lignocaine to GON in 180 patients.169 derived significant pain relief lasting 10-77 days( mean 23 days)

Anthony M. Cervicogenic headache:. Clin Exp Rheumatol. 2000;18(suppl. 19):S59-S64.

MIGRAINE CLUSTER NDPH HC OTHERNumber Patients

54 19 10 7 11

Number injections

57 22 16 10 11

Complete response

9 10 4 1 2

Partial response

17 3 6 5 5

47 CEH patients 2 weekly GON blocks -1 to 12 injections . 95 pc achieved 6 months pain relief. Efficacy increased with number of injections.

Naja ZM, El-Rajab M, Al-Tannir MA et al.Pain Pract. 2006;6:278-284.

27 Migraine patients given GON/SON blocks alternate days between 5 and 10 ib total. 85% obtained 50 % improvement at 6 months.Caputi CA, Firetto V.  Headache. 1997;37:174-179.

Reversal of allodynia, headache reduction.

Study 1-17/19 patients had 46% reduction in pain and 75% reduction in allodynia 15 mins after block.

Ashkenazi A, Young WB. . Headache. 2005;45:350-354. 

Study 2-25 patients given block.Headache 64% better,allodynia 75% better , photophobia 67% better

No DB studies but effective in supraorbital neuralgia.

18 patients with supraorbital neuralgia all responded to SON injection

1. Incidence 94% in migraine,29% in controls. 42% in temporal region ,33% suboccipital

2. 52 migraine patients evaluated after series of injections evaluated 4 weeks after injection. 60%much improved,26% reverted to episodic migraine

3.Cluster-5/6 patients had cluster attack aborted in 15 minutes.6/7 had attacks prevented.

Calandre EP, Hidalgo J, Garcia-Leiva etal.Eur J Neurol 2006, 13:244-249.

No benefit Benefit %pain decrease

Duration benefit

Medication overuser

11 14 71% 5.5 weeks

Non-overuser

13 70 85% 6.1 weeks