Evans Adam G, Joseph Kardeem S, Samouil Marc M, Hill Dorian S, Ibrahim Maryo M, Assi Patrick E, Joseph Jeremy T, Kassis Salam Al
School of Medicine, Meharry Medical College, Nashville, TN, USA.
Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
J Anaesthesiol Clin Pharmacol. 2023 Apr-Jun;39(2):170-180. doi: 10.4103/joacp.JOACP_62_21. Epub 2023 Apr 25.
Migraine surgeons have identified six "trigger sites" where cranial nerve compression may trigger a migraine. This study investigates the change in headache severity and frequency following nerve block of the occipital trigger site. This PRISMA-compliant systematic review of five databases searched from database inception through May 2020 is registered under the PROSPERO ID: CRD42020199369. Only randomized controlled trials utilizing injection treatments for headaches with pain or tenderness in the occipital scalp were included. Pain severity was scored from 0 to 10. Headache frequency was reported as days per week. Included were 12 RCTs treating 586 patients of mean ages ranging from 33.7 to 55.8 years. Meta-analyses of pain severity comparing nerve blocks to baseline showed statistically significant reductions of 2.88 points at 5 to 20 min, 3.74 points at 1 to 6 weeks, and 1.07 points at 12 to 24 weeks. Meta-analyses of pain severity of nerve blocks compared with treatment groups of neurolysis, pulsed radiofrequency, and botulinum toxin type A showed similar headache pain severity at 1 to 2 weeks, and inferior improvements compared with the treatment groups after 2 weeks. Meta-analyses of headache frequency showed statistically significant reductions at 1 to 6-week follow-ups as compared with baseline and at 1 to 6 weeks as compared with inactive control injections. The severity and frequency of occipital headaches are reduced following occipital nerve blocks. This improvement is used to predict the success of migraine surgery. Future research should investigate spinous process injections with longer follow-up.
偏头痛外科医生已确定了六个“触发点”，颅神经受压可能在这些部位引发偏头痛。本研究调查枕部触发点神经阻滞术后头痛严重程度和发作频率的变化。这项符合PRISMA标准的系统评价检索了从数据库建立至2020年5月的五个数据库，登记号为PROSPERO ID：CRD42020199369。仅纳入了对枕部头皮有疼痛或压痛的头痛采用注射治疗的随机对照试验。疼痛严重程度从0至10分进行评分。头痛发作频率以每周发作天数报告。纳入了12项随机对照试验，治疗了586例患者，平均年龄在33.7至55.8岁之间。将神经阻滞与基线进行比较的疼痛严重程度的荟萃分析显示，在5至20分钟时统计学上显著降低2.88分，在1至6周时降低3.74分，在12至24周时降低1.07分。将神经阻滞的疼痛严重程度与神经溶解、脉冲射频和A型肉毒毒素治疗组进行比较的荟萃分析显示，在1至2周时头痛疼痛严重程度相似，但在2周后与治疗组相比改善较差。头痛发作频率的荟萃分析显示，与基线相比，在1至6周的随访中以及与无效对照注射相比，在1至6周时统计学上显著降低。枕部神经阻滞后枕部头痛的严重程度和发作频率降低。这种改善可用于预测偏头痛手术的成功率。未来的研究应调查棘突注射并进行更长时间的随访。
