Department of Neurology, University of California, Los Angeles, Los Angeles, California.
University of California, San Diego School of Medicine, San Diego, California.
Pain Med. 2022 Oct 29;23(11):1851-1857. doi: 10.1093/pm/pnac080.
Diagnosis of patients with occipital headache can be challenging, as both primary and secondary causes must be considered. Our study assessed how often migraine is screened for, diagnosed, and treated in patients receiving greater occipital nerve blocks (GONBs) in a pain clinic.
Institutional review board-approved, retrospective observational study.
Academic multidisciplinary pain clinic.
One hundred forty-three consecutive patients who received GONBs.
About 75% of patients had been evaluated by neurologists and about 25% by non-neurologist pain specialists only, and 62.2% of patients had photophobia, phonophobia, and nausea assessed. Compared with patients who had been evaluated by non-neurologists, patients who had been evaluated by a neurologist were more likely to have photophobia, phonophobia, and nausea assessed (75.9% vs 20.0%, odds ratio [OR] 12.6, 95% confidence interval [CI] 4.90 to 32.2); more likely to be diagnosed with migraine (48.1% vs 14.3%, OR 5.6, 95% CI 2.0 to 15); less likely to be diagnosed with occipital neuralgia (39.8% vs 65.7%, OR 0.3, 95% CI 0.2 to 0.8); and equally likely to be diagnosed with cervicogenic headache (21.3% vs 25.7%, OR 0.8, 95% CI 0.3 to 1.9). Among patients diagnosed with migraine, 82.5% received acute migraine treatment, 89.5% received preventive migraine treatment, and 52.6% were documented as receiving migraine lifestyle counseling.
Of the patients in this study who had occipital headache and received GONBs, 62.2% were assessed for migraine, and most received appropriate acute, preventive, and lifestyle treatments when diagnosed. Patients seen by neurologists were significantly more likely to be screened for and diagnosed with migraine than were those evaluated by non-neurologist pain medicine specialists only. All clinicians should remain vigilant for migraine in patients with occipital headache.
枕部头痛的诊断具有一定挑战性，因为必须考虑到原发性和继发性病因。我们的研究评估了在疼痛诊所接受枕大神经阻滞（GONB）的患者中，偏头痛的筛查、诊断和治疗频率。
机构审查委员会批准的回顾性观察研究。
学术多学科疼痛诊所。
143 例连续接受 GONB 的患者。
约 75%的患者曾接受过神经科医生评估，约 25%的患者仅接受过非神经科疼痛专家评估，62.2%的患者接受了畏光、恐声和恶心评估。与非神经科医生评估的患者相比，接受神经科医生评估的患者更有可能接受畏光、恐声和恶心评估（75.9% vs 20.0%，比值比[OR] 12.6，95%置信区间[CI] 4.90 至 32.2）；更有可能被诊断为偏头痛（48.1% vs 14.3%，OR 5.6，95% CI 2.0 至 15）；不太可能被诊断为枕大神经痛（39.8% vs 65.7%，OR 0.3，95% CI 0.2 至 0.8）；同样不太可能被诊断为颈源性头痛（21.3% vs 25.7%，OR 0.8，95% CI 0.3 至 1.9）。在被诊断为偏头痛的患者中，82.5%接受了急性偏头痛治疗，89.5%接受了预防性偏头痛治疗，52.6%的患者接受了偏头痛生活方式咨询的记录。
在这项研究中，患有枕部头痛并接受 GONB 的患者中，62.2%接受了偏头痛评估，大多数患者在确诊后接受了适当的急性、预防性和生活方式治疗。接受神经科医生评估的患者明显比仅接受非神经科疼痛医学专家评估的患者更有可能接受偏头痛筛查和诊断。所有临床医生都应警惕患有枕部头痛的患者发生偏头痛。
