A Randomized, Sham-Controlled Trial of Bilateral Greater Occipital Nerve Blocks With Bupivacaine for Acute Migraine Patients Refractory to Standard Emergency Department Treatment With Metoclopramide

Headache
Benjamin W FriedmanE John Gallagher

Abstract

Greater occipital nerve block (GONB) is thought to be an effective treatment for acute migraine, though no randomized efficacy data have been published for this indication. We hypothesized that bilateral GONB with bupivacaine would provide greater rates of headache freedom than a sham injection among a population of emergency department (ED) patients who reported persistence of moderate or severe headache despite standard treatment with intravenous metoclopramide. This was a randomized clinical trial conducted in 2 urban EDs. Patients with acute migraine who reported persistence of a moderate or severe headache for at least 1 hour or longer after treatment with 10 mg of intravenous metoclopramide were randomized to bilateral GONB with a total of 6 mL of 0.5% bupivacaine or bilateral intradermal scalp injection with a total of 1 mL of 0.5% bupivacaine. The primary outcome was complete headache freedom 30 minutes after the injection. An important secondary outcome was sustained headache relief, defined as achieving a headache level of mild or none in the ED and maintaining a level of mild or none without the use of any additional headache medication for 48 hours. Over a 31 month period, 76 patients were screened for participation...Continue Reading

References

Jan 19, 2010·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Benjamin W FriedmanRichard B Lipton
Mar 3, 2012·Cephalalgia : an International Journal of Headache·Peer Tfelt-HansenUNKNOWN International Headache Society Clinical Trials Subcommittee
Jun 19, 2013·Cephalalgia : an International Journal of Headache·UNKNOWN Headache Classification Committee of the International Headache Society (IHS)
Jun 21, 2014·Cephalalgia : an International Journal of Headache·Benjamin W FriedmanE John Gallagher
Nov 5, 2014·Global Journal of Health Science·Davood KashipazhaShahram Tarahomi
Dec 3, 2014·The Journal of Emergency Medicine·Crystal L Voigt, Maurice O Murphy
Dec 17, 2014·Cephalalgia : an International Journal of Headache·Esma DilliDavid Dodick
Dec 21, 2014·Cephalalgia : an International Journal of Headache·Matthew S Robbins
Jun 12, 2016·Cephalalgia : an International Journal of Headache·María L CuadradoJosé A Arias
Jun 15, 2016·Cephalalgia : an International Journal of Headache·María L CuadradoCristina Fernández-Pérez
Aug 29, 2017·The American Journal of Emergency Medicine·Yongguo TangXuejun Zhang
Mar 15, 2018·Journal of the American Board of Family Medicine : JABFM·Sorcha M AllenMartina Mookadam

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Citations

Aug 11, 2020·Pain Research & Management : the Journal of the Canadian Pain Society = Journal De La Société Canadienne Pour Le Traitement De La Douleur·J D GerkenS Tafelski
Mar 20, 2020·Current Neurology and Neuroscience Reports·Jennifer Robblee, Kate W Grimsrud
Apr 11, 2021·Regional Anesthesia and Pain Medicine·Sarah LaingAllan M Cyna
May 29, 2021·Continuum : Lifelong Learning in Neurology·Matthew S Robbins
May 19, 2021·Neurology India·Debashish ChowdhuryAnkit Mundra
May 11, 2021·Neurology. Clinical Practice·Heidi B Schwarz, Matthew S Robbins
May 11, 2021·Neurology. Clinical Practice·Paul G MathewRegina Krel

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