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Systematic review
Effectiveness and safety profile of greater occipital nerve blockade in cluster headache: a systematic review
  1. Alexander Gordon1,2,
  2. Thomas Roe3,
  3. María Dolores Villar-Martínez1,4,
  4. David Moreno-Ajona1,4,
  5. Peter J Goadsby1,4,
  6. Jan Hoffmann1,4
  1. 1 Wolfson Centre for Age-Related Diseases, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
  2. 2 Torbay and South Devon NHS Foundation Trust, Torquay, UK
  3. 3 University Hospitals Plymouth NHS Trust, Plymouth, UK
  4. 4 NIHR-Wellcome Trust King’s Clinical Research Facility/SLaM Biomedical Research Centre, King's College Hospital, London, UK
  1. Correspondence to Dr Jan Hoffmann, Wolfson Centre for Age-Related Diseases, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 9PJ, UK; jan.hoffmann{at}


Background Greater occipital nerve (GON) blockade is a short-term preventive therapy for cluster headache (CH). We conducted a systematic review to evaluate the effectiveness and safety of GON blockade in patients with CH.

Methods On 23 October 2020, we searched MEDLINE, Embase, Embase Classic, PsycINFO, CINAHL, CENTRAL and Web of Science databases from their inception date. Studies included participants with a CH diagnosis who received corticosteroid and local anaesthetic suboccipital region injections. Outcomes were change in the frequency/severity/duration of attacks; proportion of participants responding to treatment, time to attack freedom from an attack, change in attack bout length and/or the presence of adverse effects after GON blockade. Risk of bias was assessed with the Cochrane Risk of Bias V.2.0 (RoB2)/Risk of Bias in Non-randomized Studies - of Interventions (ROBINS- I) tools and a specific tool for case reports/series.

Results Two RCTs, eight prospective and eight retrospective studies, and four case reports were included in the narrative synthesis. Every effectiveness study found a significant response in one or more of frequency/severity/duration of individual attacks or proportion of patients responding to treatment (47.8%–100.0%). There were five instances of potentially irreversible adverse effects. A higher injectate volume and use of concurrent prophylaxis may be associated with an increased likelihood of response. Methylprednisolone may have the best safety profile of available corticosteroids.

Discussion GON blockade is safe and effective for CH prevention. Higher injectate volumes may improve likelihood of response, and the likelihood of serious adverse events may be reduced by using methylprednisolone.

PROSPERO registration number CRD42020208435.

Data availability statement

No data are available. As this is a systematic review, the data that this article is based on is already publicly available.

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Data availability statement

No data are available. As this is a systematic review, the data that this article is based on is already publicly available.

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  • Contributors All authors were involved in the planning and reporting of the work. AG, TR and MDV-M were responsible for the conduct of the research. AG and JH were responsible for the overall content of this article as guarantors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests AG, TR, MDV-M and DM-A report no competing interests. PJG, over the last 36 months and unrelated to this submission, grants and personal fees from Amgen and Eli-Lilly and Company, grant from Celgene, and personal fees from Aeon Biopharma, Allergan, Biohaven Pharmaceuticals Inc., Clexio, Electrocore LLC, eNeura, Epalex, GlaxoSmithKline, Impel Neuropharma, Lundbeck, MundiPharma, Novartis, Pfizer, Praxis, Sanofi, Santara Therapeutics, Satsuma, Teva Pharmaceuticals, Trigemina Inc. and WL Gore; personal fees for advice through Gerson Lehrman Group and Guidepoint; fees for educational materials from Massachusetts Medical Society, Medery, Medlink, PrimeEd, UptoDate and WebMD; publishing royalties from Oxford University Press and Wolters Kluwer; and for medicolegal advice in headache and a patent magnetic stimulation for headache (No. WO2016090333 A1) assigned to eNeura without fee. JH reports honoraria for consulting activities and/or serving on advisory boards from Abbvie, Allergan, Autonomic Technologies Inc., Cannovex BV, Chordate Medical AB, Eli Lilly, Hormosan Pharma, Lundbeck, Novartis, Sanofi and Teva; holds stock options from Chordate Medical AB; received personal fees for medicolegal work as well as from NEJM Journal Watch, Oxford University Press, Quintessence Publishing, Sage Publishing and Springer Healthcare; reports a research grant from Bristol Myers Squibb; serves as associate editor for Cephalalgia, Cephalalgia Reports, Journal of Oral & Facial Pain and Headache, Frontiers in Pain Research, as well as for the Journal of Headache and Pain. All these activities are unrelated to the submitted work.

  • Provenance and peer review Not commissioned; externally peer reviewed.