Efficacy Of Greater Occipital Nerve Block With Or Without Bupivacaine In Chronic Migraineurs

OBJECTIVE: We conducted a retrospective comparison of migraine patients who received greater occipital nerve block (GONB) with or without bupivacaine at a neurology community clinic. BACKGROUND: Bupivacaine is a longer acting local anesthetic as compared to lidocaine. Both these local anesthetic are routinely used in greater occipital nerve block (GONB) in patients with chronic migraineurs. DESIGN/METHODS: We conducted a retrospective analysis of chronic migraineurs who received GONB at a single community neurology clinic. Patients were grouped into Group A, those who received lidocaine 1% with triamcinolone 40 mg and Group B those who received lidocaine 1%, bupivacaine 0.25% and triamcinolone 40 mg from May 2012 to August 2012. Following data was extracted: demographics, medical history, medications, visual analogue scale (VAS) before and after the GONB, duration of pain relief immediately after GONB and side effects from GONB. RESULTS: Fifteen patients with chronic migraine had their first GONB done between May-August 2012 at our neurology clinic. Seven patients were in group A (6F;1 M; AVG Age: F- 34.8 years, M-55 years) and eight patients were in group B (5F; 3M; Avg age F :39.6 years; M 56.6 years). VAS avg prior to GONB in group A was 6.4 and 6.75 in group B. VAS avg after GONB was 6.4 in group A and 5. 87 in group B. Duration for pain relief after GONB was 23.7days (Range 1-90 days) in group A and 22.6 days (range 4-90 days) in group B. All patients tolerated the procedure fairly well except one in group A who had transient dizziness. CONCLUSIONS: Greater occipital nerve block is a safe procedure used for the treatment of migraine headache. In our preliminary data, we did not find any difference in the duration of pain relief after GONB with or without bupivacaine. Prospective studies with larger sample size are needed. Disclosure: Dr. Siddiqui has nothing to disclose. Dr. Caplinger has nothing to disclose.