Objective: To determine whether adding triamcinolone to local anesthetics increased the efficacy of GONB and trigger point injections (TPIs) for transformed migraine (TM).
Methods: TM patients were randomized 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 associated symptoms severity 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 anesthetics when performing GONB and TPIs was not associated with improved outcome in this sample of transformed migraine patients.
- greater occipital nerve block
- local anesthetics
- transformed migraine