Department of Neurology, University of Health Sciences, Kecioren Training and Research Hospital, Ankara, Turkey.
Department of Emergency Medicine, University of Health Sciences, Kecioren Training and Research Hospital, Ankara, Turkey.
Acta Neurol Scand. 2018 Sep;138(3):212-218. doi: 10.1111/ane.12952. Epub 2018 May 10.
This study aimed to evaluate the effectiveness of a greater occipital nerve (GON) blockade against a placebo and classical treatments (non-steroidal anti-inflammatory drugs + metoclopramide) among patients who were admitted to the emergency department (ED) with acute migraine headaches.
This prospective-randomized controlled study was conducted on patients with acute migraine headaches. The patients were randomly assigned to 3 treatment groups: the GON blockade group (nerve blockade with bupivacaine), the placebo group (injection of normal saline into the GON area), and the intravenous (IV) treatment group (IV dexketoprofen and metoclopramide). Sixty acute migraine attack patients were assigned to 3 groups of 20 patients each. The pain severity was assessed at 5, 15, 30, and 45 minutes with a 10-point pain scale score (PSS).
The mean decreases in the 5-, 15-, 30-, and 45-minutes PSS scores were greater in the GON blockade group than in the dexketoprofen and placebo groups. When comparing the 30- and 45-minutes PSS changes, a statistically significant difference was found among the 3 groups (P = .03 and P = .03, respectively).
A GON blockade was as effective as an IV dexketoprofen + metoclopramide treatment and superior to a placebo in patients with acute migraine headaches. Despite being an invasive procedure, a GON blockade might be an effective option for acute migraine treatment in the ED due to its rapid, easy, and safe application.
本研究旨在评估相较于安慰剂和传统治疗（非甾体抗炎药+甲氧氯普胺），在因急性偏头痛就诊于急诊科的患者中，使用大枕神经（GON）阻滞的效果。
本前瞻性随机对照研究纳入了急性偏头痛患者。患者被随机分为 3 个治疗组：GON 阻滞组（布比卡因神经阻滞）、安慰剂组（GON 区域注射生理盐水）和静脉（IV）治疗组（IV 右酮洛芬和甲氧氯普胺）。60 例急性偏头痛发作患者被分为每组 20 例的 3 个组。采用 10 分疼痛量表（PSS）在 5、15、30 和 45 分钟评估疼痛严重程度。
GON 阻滞组的 5、15、30 和 45 分钟 PSS 评分的平均下降幅度大于右酮洛芬和安慰剂组。在比较 30 和 45 分钟 PSS 变化时，3 组之间存在统计学显著差异（P=0.03 和 P=0.03）。
与 IV 右酮洛芬+甲氧氯普胺治疗相比，GON 阻滞与 IV 右酮洛芬+甲氧氯普胺治疗同样有效，且优于安慰剂，在急性偏头痛患者中。尽管是一种侵入性操作，但由于其快速、简便、安全的应用，GON 阻滞可能是急诊科急性偏头痛治疗的有效选择。
