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Greater occipital nerve block using local anesthetics alone or with triamcinolone for transformed migraine: A randomized comparative study
  1. Avi A Ashkenazi (avi.ashkenazi{at}
  1. Thomas Jefferson University, United States
    1. Rebecca Matro (rebecca.matro{at}
    1. Jefferson Medical College, United States
      1. James W Shaw (jwshaw{at}
      1. University of Illinois, United States
        1. Muhammad A Abbas (muhammad.abbas{at}
        1. Thomas Jefferson University, United States
          1. Stephen D Silberstein (stephen.silberstein{at}
          1. Thomas Jefferson University, United States


            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
            • triamcinolone

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