Greater occipital nerve block using local anaesthetics alone or with triamcinolone for transformed migraine: a randomised comparative study
- 1Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA
- 2Jefferson Medical College, Philadelphia, PA, USA
- 3College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
- Avi Ashkenazi, MD, Department of Neurology, Thomas Jefferson University, 111 South 11th Street, Suite 8130, Philadelphia, PA 19107, USA; avi.ashkenazi{at}jefferson.edu
- Received 7 May 2007
- Revised 24 July 2007
- Accepted 25 July 2007
- Published Online First 6 August 2007
Abstract
Objective: To determine whether adding triamcinolone to local anaesthetics increased the efficacy of greater occipital nerve block (GONB) and trigger-point injections (TPIs) for transformed migraine (TM).
Methods: Patients with TM were randomised to receive GONB and TPIs using lidocaine 2% and bupivacaine 0.5% + either saline or triamcinolone 40 mg. We assessed the severity of headache and associated symptoms before and 20 minutes after injection. Patients documented headache and severity of associated symptoms for 4 weeks after injections. Changes in symptom severity were compared between the two groups.
Results: Thirty-seven patients were included. Twenty minutes after injection, mean headache severity decreased by 3.2 points in group A (p<0.01) and by 3.1 points in group B (p<0.01). Mean neck pain severity decreased by 1.5 points in group A (p<0.01) and by 1.7 points in group B (p<0.01). Mean duration of being headache-free was 2.7±3.8 days in group A and 1.0±1.1 days in group B (p = 0.67). None of the outcome measures differed significantly between the two groups. Both treatments were well tolerated.
Conclusions: Adding triamcinolone to local anaesthetics when performing GONB and TPIs was not associated with improved outcome in this sample of patients with TM.
Footnotes
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Competing interests: None.
