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Greater occipital nerve block using local anaesthetics alone or with triamcinolone for transformed migraine: a randomised comparative study
  1. A Ashkenazi1,
  2. R Matro2,
  3. J W Shaw3,
  4. M A Abbas1,
  5. S D Silberstein1
  1. 1
    Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA
  2. 2
    Jefferson Medical College, Philadelphia, PA, USA
  3. 3
    College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
  1. Avi Ashkenazi, MD, Department of Neurology, Thomas Jefferson University, 111 South 11th Street, Suite 8130, Philadelphia, PA 19107, USA; avi.ashkenazi{at}


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.

  • greater occipital nerve block
  • local anaesthetics
  • triamcinolone
  • transformed migraine

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  • Competing interests: None.