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Tension-Type Headache
Published in Gary W. Jay, Clinician’s Guide to Chronic Headache and Facial Pain, 2016
Cervicogenic headache (CGHA) is always unilateral and associated with a neck trigger point (40,41). As previously stated, the differentiation between trigger points from tender points is critical in order to distinguish CGHA from TTH (14,42). Tenderness is evident as a local pain in response to manual pressure, while a trigger point is when there is referred pain from one area to another. In the case of CGHA, the origin of the pain is from the neck and is referred to the head and face (43). The most common site of CGHA is the occipital nerve emergence. On the other hand, TTH involves bilateral pain with muscle tenderness during and between episodes in areas such as the scalp, temporal area, lateral pterygoid, masseter, sternocleidomastoid, and trapezius. Thus, the presence of neck tenderness can frequently mislead practitioners to a wrong diagnosis of CGHA. Nerve blockade is both therapeutic and diagnostic of CGHA. One study compared the pain reduction after greater occipital nerve block in cervicogenic headache, tension-type headache, and migraine without aura, which demonstrated that the patients with cervicogenic headaches had more marked reduction in pain than the other groups. An index of pain reduction was pain in the forehead, which was found to be reduced in 77% of the patients with cervicogenic headache (44). In another study that examined greater occipital nerve blocks in only chronic TTHs, the treatment was found to be minimally effective and was actually pronociceptive in some patients (45).
Cryoanalgesia
Published in Harald Breivik, William I Campbell, Michael K Nicholas, Clinical Pain Management, 2008
Gunnvald Kvarstein, Henrik Högström
In mixed trigeminocervical pain, a local anesthetic block can be used to rule out a cervical cause. Sjaastad et al.44 included pain relief after an occipital nerve block as a criterion in the diagnosis of cervicogenic headache. Peripheral blocks (GON) seem to be equally effective as central blocks over the facet joint C2-3 (TON).45 Transforming this diagnostic procedure into a long-term therapeutic modality by percutaneous cryoanalgesia of the occipital nerves, however, has so far caught little interest. There are no randomized control trial (RCT)-studies available supporting cryoneurolysis for occipital pain. From an ongoing randomized study we have gathered considerable clinical experience with the method, and the preliminary data are encouraging (Högström, unpublished results). Many patients report substantial pain relief and a reduction in autonomic, cognitive, and muscle dysfunction. In some patients we have observed an improved pain relief after repeated ablations, but the duration of pain relief remains unchanged, at three to six months.
Bilateral greater occipital nerve block for headache after corrective spinal surgery: a case report
Published in Southern African Journal of Anaesthesia and Analgesia, 2018
Edmundo Pereira de Souza Neto, José Luis Martinez, Kathryn Dekoven, Francoise Yung, Sandra Lesage
Bilateral greater occipital nerve (BGON) block is an interesting alternative to epidural blood patch because it is easy to perform and, in expert hands, has a minimal risk of side effects.3,5,8 The evoked risks related to greater occipital nerve block are haematoma, pain, vasovagal reaction, dizziness, infection, alopecia and cutaneous atrophy.3–5,8,12–14 The conditions that have been treated with BGON block are occipital neuralgia and cervicogenic headache.7 The greater occipital nerve takes sensorial fibres from the C2 and C3 segments of the spinal cord. It separates from the dorsal ramus of the C2 segment, taking a fine branch from the C3 segment and innervating the posterior medial aspect of the scalp.14,15 The BGON block can initiate an inhibitory process that shuts down several symptom generators, alleviating allodynia and headache.8
Occipital osteomylelitis and epidural abscess after occipital nerve block: A case report
Published in Canadian Journal of Pain, 2018
Sean D. Christie, Nelofar Kureshi, Ian Beauprie, Renn O. Holness
Occipital nerve block is a common diagnostic and therapeutic tool used in the course of occipital neuralgia, and injections are commonly performed by both family physicians and specialists. Ultrasound-guided approaches are superior to landmark techniques for favorable outcome with occipital nerve block.11 The greater occipital nerve (GON) provides cutaneous innervation to the posterior scalp, whereas the lesser occipital nerve supplies scalp sensation lateral to the GON to the posterior auricle. In patients with occipital neuralgia, the GON may be blocked alone or with the lesser occipital nerve for peripheral nerve block. Local anesthetics including lidocaine, mepivacaine, and bupivacaine may be injected as monotherapy or as combinations. Corticosteroids may be added for patients who do not respond to infiltration with local anesthetic only.