Yanuck Justin, Shah Sagar, Jen Maxwell, Dayal Rakhi
University of California, Irvine, Department of Emergency Medicine, Orange, California.
University of California, Irvine, Department of Anesthesiology, Orange, California.
Clin Pract Cases Emerg Med. 2019 Jan 22;3(1):6-10. doi: 10.5811/cpcem.2019.1.39910. eCollection 2019 Feb.
Migraines are consistently among the top 20 primary coded diagnoses in emergency departments, constituting 4.5% of all chief complaints. In a significant subset of these, pain arises from the occipital region innervated by the greater (GON) and lesser occipital nerve. In this case series, we present three patients with occipital migraines who received GON blockade with 1% lidocaine. The blockade was performed only after first-line treatment with metoclopramide and possibly additional medications as ordered by triage physician, failed to adequately alleviate pain by 40 minutes after medication administration. Patients were contacted a minimum of seven days following treatment. All three patients experienced significant analgesia and relief of symptoms within 15 minutes of blockade and sustained relief through a seven-day follow-up period.
偏头痛一直是急诊科前20种主要编码诊断之一，占所有主要诉求的4.5%。在其中很大一部分病例中，疼痛源自由枕大神经（GON）和枕小神经支配的枕部区域。在本病例系列中，我们介绍了3例枕部偏头痛患者，他们接受了1%利多卡因的枕大神经阻滞。仅在使用甲氧氯普胺进行一线治疗以及分诊医生根据医嘱可能使用的其他药物在给药后40分钟未能充分缓解疼痛后，才进行阻滞。治疗后至少7天与患者进行了联系。所有3例患者在阻滞后15分钟内均经历了显著的镇痛效果和症状缓解，并在为期7天的随访期内持续缓解。
