Efficacy and safety of ultrasound-guided peripheral nerve blocks in management of chronic resistant migraine

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BACKGROUND: Migraine is a common primary headache disorder with different treatment modalities emerging as ultrasound guided peripheral nerve blocks. We compared the efficacy and safety of ultrasound guided bilateral sphenopalatine ganglion (SPG) block versus bilateral greater occipital nerve (GON) block, in chronic resistant migraine patients and controls. METHODS: This study was an interventional randomized controlled trial, including 53 patients, 22 in sphenopalatine ganglion arm, 21 greater occipital nerve arm and 10 in sham group. All patients were assessed initially by headache diary (for 3 months), HIT-6 and MIDAS scales. The patients (blindly allocated) underwent nerve block ultrasound guided, then followed up after one month by headache diary and HIT- 6 scale and three months by MIDAS. Results were analysed on SPSS, using mixed AVOVA and Tukey's Post-Hoc analysis, Fisher's exact and paired t-test. RESULTS: The two groups were matched as regards the gender, age, type of migraine, frequency and years lived with headache. The study revealed that GON and SPG block, were equally effective (p < 0.05) as regards reducing the headache diary parameters, as well as the total pain index and the functional impact on HIT-6 and MIDAS scale. SPG block was more effective in patients with autonomic manifestations and temporal location of pain. CONCLUSION: Ultrasound guided SPG is as effective as GON as a treatment modality for chronic resistant migraine and may be more useful in the presence of autonomic manifestations and temporal location of pain.

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