Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila - L'Aquila, Italy.
Nursing Section, Department of Health, Life, and Environmental Sciences, University of L'Aquila - L'Aquila, Italy.
Expert Rev Neurother. 2021 May;21(5):591-597. doi: 10.1080/14737175.2021.1903320. Epub 2021 Mar 29.
Cervicogenic headache (CGH) is a secondary headache disorder caused by cervical spine or neck soft tissue lesions. Despite few available evidence-based pharmacological treatments are available, greater occipital nerve blocks (GONBs) are considered as therapeutic option.
In June 2020, we conducted a systematic review on Pubmed and Scopus, to summarize effectiveness and safety of GONBs in treating CGH. We included 5 observational studies and 3 nonrandomized trials reporting clinical outcomes of 140 CGH patients after GONBs. Authors performed unilateral GONBs during interictal phase (five studies) or during pain, injecting local anesthetic (four studies) or both local anesthetic and steroid (three studies) at variable timepoints. In 5 studies mean pain reduction ranged from -8.2 (at 2 weeks after the first block) to -0.1 (at 1 month after the third block); one study documented 66.6% reduction of pain intensity and another study documented a significant median reduction of pain intensity at 3 months (decreased from 5.5 to 2.3) and not at 9 months. Three studies reported minor adverse events.
Few available studies suggest that GONBs are effective and safe in treating CGH. GONB is a high tolerable, low cost and repeatable procedure. Larger and randomized studies are needed.
颈源性头痛（CGH）是一种由颈椎或颈部软组织病变引起的继发性头痛疾病。尽管目前仅有少数基于证据的药物治疗方法，但更多的枕大神经阻滞（GONB）被认为是一种治疗选择。
2020 年 6 月，我们在 PubMed 和 Scopus 上进行了系统评价，总结了 GONB 治疗 CGH 的有效性和安全性。我们纳入了 5 项观察性研究和 3 项非随机试验，这些研究报告了 140 例 CGH 患者接受 GONB 后的临床结果。作者在间歇期（五项研究）或疼痛时（四项研究）或同时注射局部麻醉剂（三项研究）进行单侧 GONB，注射时间不同。在五项研究中，疼痛缓解的平均值从 -8.2（第一次阻滞后 2 周）到 -0.1（第三次阻滞后 1 个月）不等；一项研究记录了疼痛强度降低 66.6%，另一项研究记录了疼痛强度的中位数在 3 个月时（从 5.5 降低到 2.3）显著降低，而在 9 个月时没有降低。三项研究报告了轻微的不良事件。
少数现有研究表明，GONB 治疗 CGH 有效且安全。GONB 是一种高耐受性、低成本且可重复的治疗方法。需要更大规模和随机的研究。
