Efficacy and safety of greater occipital nerve block for the treatment of cervicogenic headache: a systematic review

ABSTRACT

Introduction

Cervicogenic headache (CGH) is a secondary headache disorder caused by cervical spine or neck soft tissue lesions. Despite few available evidence-based pharmacological treatments are available, greater occipital nerve blocks (GONBs) are considered as therapeutic option.

Area covered

In June 2020, we conducted a systematic review on Pubmed and Scopus, to summarize effectiveness and safety of GONBs in treating CGH. We included 5 observational studies and 3 nonrandomized trials reporting clinical outcomes of 140 CGH patients after GONBs. Authors performed unilateral GONBs during interictal phase (five studies) or during pain, injecting local anesthetic (four studies) or both local anesthetic and steroid (three studies) at variable timepoints. In 5 studies mean pain reduction ranged from −8.2 (at 2 weeks after the first block) to −0.1 (at 1 month after the third block); one study documented 66.6% reduction of pain intensity and another study documented a significant median reduction of pain intensity at 3 months (decreased from 5.5 to 2.3) and not at 9 months. Three studies reported minor adverse events.

Expert opinion

Few available studies suggest that GONBs are effective and safe in treating CGH. GONB is a high tolerable, low cost and repeatable procedure. Larger and randomized studies are needed.

KEYWORDS:

• Cervicogenic headache
• greater occipital nerve block
• headache treatment
• secondary headache
• systematic review

Article highlights

• Physical therapy is considered as the first line of treatment for CGH, while GONBs are considered as a therapeutic option.

• The authors performed a systematic review to summarize available data about the efficacy and safety of GONBs for the treatment of CGH.

• GONBs are a safe and effective treatment for CGH in the acute and interictal phase, despite available evidence are few and heterogenous.

• Larger and randomized studies are needed to confirm the efficacy of the procedure, refine patient selection and injection protocols.

Declaration of interest

V Caponnetto had a financial relationship (member of advisory board) with Novartis. R Ornello has received sponsorship to attend meetings from Novartis and Teva. S Sacco had a financial relationship (lecturer or member of advisory board) with Abbott, Allergan, Novartis, Teva, and Eli Lilly. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or conflict with the subject matter or materials discussed in this manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Availability of data and material

Extracted and analyzed data are available from the authors upon request.

Additional information

Funding

This paper was not funded.