Steroid Occipital Nerve Block for Headache
Recruiting in Palo Alto (17 mi)
Overseen byCarrie Robertson, MD
Age: 18+
Sex: Any
Travel: May Be Covered
Time Reimbursement: Varies
Trial Phase: Phase 4
Recruiting
Sponsor: Mayo Clinic
Disqualifiers: Cluster headache, Pregnancy, Infection, others
No Placebo Group
Prior Safety Data
Trial Summary
What is the purpose of this trial?Currently there is limited evidence of benefit for the addition of steroids to occipital nerve blocks for treatment of headache, and not all steroids have been explored. The purpose of this research is to learn more about whether the addition of a specific kind of steroid (dexamethasone) provides any additional benefit to nerve blocks.
Will I have to stop taking my current medications?
The trial requires that you stay on your current preventative medication without any changes during the study.
What data supports the effectiveness of this treatment for headaches?
Research shows that blocking the greater occipital nerve, often with steroids, can help relieve pain in various types of headaches, including migraines and cluster headaches. Studies have found that these nerve blocks can be beneficial for patients, providing pain relief and helping manage headache symptoms.
12345Is the steroid occipital nerve block generally safe for humans?
Occipital nerve blocks, which may include steroids like dexamethasone, are generally considered safe, but there are some risks. In a study, only 3% of patients reported minor adverse reactions, but rare cases of temporary facial nerve palsy and infection have been reported. Additionally, repeated use of steroid-containing blocks can lead to Cushing syndrome, a condition caused by high levels of steroids in the body.
678910How is the steroid occipital nerve block treatment for headaches different from other treatments?
The steroid occipital nerve block treatment is unique because it involves injecting steroids and sometimes local anesthetics directly into the occipital nerve, which can provide targeted relief for headaches. This method is different from oral medications as it delivers the treatment directly to the nerve area, potentially offering faster and more localized pain relief.
2341112Eligibility Criteria
This trial is for individuals who can consent, have been stable on headache prevention meds for at least a month, and suffer from headaches like occipital neuralgia or migraines. It's not for pregnant people, those with allergies to the drugs used, infections at the injection site, certain head or neck issues, or recent nerve blocks.Inclusion Criteria
Able to independently provide informed consent.
Stable on preventative medication dosing for at least 1 month prior to occipital nerve block and no change in preventative medication regimen during the course of the study.
Able to understand the requirements of the study and return for treatment.
+1 more
Exclusion Criteria
Pregnancy.
You have had a bad reaction to bupivacaine, lidocaine, or dexamethasone in the past.
You have an infection or bleeding where the injection will be given.
+3 more
Trial Timeline
Screening
Participants are screened for eligibility to participate in the trial
2-4 weeks
Treatment
Participants receive occipital nerve blocks with or without dexamethasone
1 day
1 visit (in-person)
Follow-up
Participants are monitored for safety and effectiveness after treatment
4 weeks
3 visits (virtual)
Participant Groups
The study tests if adding dexamethasone (a steroid) to an occipital nerve block helps more than just using local anesthetics (bupivacaine and lidocaine) with saline in treating headaches. Participants will receive these treatments directly around the nerves that might cause their pain.
2Treatment groups
Experimental Treatment
Active Control
Group I: Anesthetic with dexamethasone groupExperimental Treatment4 Interventions
Subjects scheduled for bilateral greater/lesser occipital nerve blocks as part of clinical care will receive standard of care medication, including lidocaine and bupivacaine and dexamethasone.
Group II: Anesthetic without steroid groupActive Control4 Interventions
Subjects scheduled for bilateral greater/lesser occipital nerve blocks as part of clinical care will receive standard of care medication, including lidocaine and bupivacaine and normal saline.
Find a Clinic Near You
Research Locations NearbySelect from list below to view details:
Mayo Clinic MinnesotaRochester, MN
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Who Is Running the Clinical Trial?
Mayo ClinicLead Sponsor
References
Efficacy of greater occipital nerve block for pain relief in patients with postdural puncture headache: A meta-analysis. [2023]This study aimed at assessing the therapeutic effectiveness of greater occipital nerve block (GONB) against postdural puncture headache (PDPH).
Greater Occipital Nerve Injection versus Oral Steroids for Short Term Prophylaxis of Cluster Headache: A Retrospective Comparative Study. [2019]To investigate our experience with oral steroid and greater occipital nerve (GON) injection with steroid as transitional treatments for cluster headache.
Blocking the greater occipital nerve: utility in headache management. [2021]Occipital nerve block has been part of headache medicine for more than half a century, with injection techniques and solutions varying greatly. Most studies have been case series and many show benefit for patients with migraine, cluster headache, and postconcussive headache. A double-blind, controlled trial of cluster headache has demonstrated that injectable steroids with local anesthetics benefit cluster headache patients. A double-blind, controlled trial of nerve blocks in occipital neuralgia, which may have actually been chronic migraine, was positive.
Occipital nerve block for the short-term preventive treatment of migraine: A randomized, double-blinded, placebo-controlled study. [2017]Occipital nerve (ON) injections with corticosteroids and/or local anesthetics have been employed for the acute and preventive treatment of migraine for decades. However, to date there is no randomized, placebo-controlled evidence to support the use of occipital nerve block (ONB) for the prevention of migraine.
Sonographic visualization and ultrasound-guided blockade of the greater occipital nerve: a comparison of two selective techniques confirmed by anatomical dissection. [2022]Local anaesthetic blocks of the greater occipital nerve (GON) are frequently performed in different types of headache, but no selective approaches exist. Our cadaver study compares the sonographic visibility of the nerve and the accuracy and specificity of ultrasound-guided injections at two different sites.
Evaluation of Occipital Nerve Blocks for Acute Pain Relief of Migraines. [2021]Migraines are a debilitating neurological disease affecting as many as 1 of 6 adults in the United States. Occipital nerve block, consisting of a local anesthetic and/or corticosteroid, has shown to be an effective treatment for the management of migraines. Occipital nerve block has been reported to reduce migraine pain scores, frequency, and duration. We aimed to evaluate the impact of occipital nerve block for acute pain relief in patients with migraines. This was a single-center retrospective observational study conducted at a 1162-bed academic medical center in Gainesville, Florida. Included patients were ≥18 years old, diagnosed with migraine with or without aura, and received at least 1 occipital nerve block. Excluded patients received nerve blocks not specific to the occipital region. The outcomes observed were migraine pain before and after administration within the same initial encounter of receiving an occipital nerve block using a numeric pain rating scale, injection direction, medications used, duration of effect and frequency of additional injections, and adverse reactions. A total of 190 patients met the inclusion criteria, with 63% rating their pain to be 6-8 of 10 prior to an occipital nerve block. After receiving an occipital nerve block, 27% of patients reported significant or immediate relief, and 42% experienced reduced pain scores of 0-2. The majority of injections were bilateral using lidocaine with dexamethasone. Only 3% of patients reported an adverse reaction. Occipital nerve block as adjunctive therapy has shown safety and efficacy in treating patients with migraines, measured by the reduction in pain.
Transient facial nerve palsy after occipital nerve block: a case report. [2014]Occipital nerve blocks are commonly performed to treat a variety of headache syndromes and are generally believed to be safe and well tolerated. We report the case of an otherwise healthy 24-year-old woman with left side-locked occipital, parietal, and temporal pain who was diagnosed with probable occipital neuralgia. She developed complete left facial nerve palsy within minutes of blockade of the left greater and lesser occipital nerves with a solution of bupivicaine and triamcinolone. Magnetic resonance imaging of the brain with gadolinium contrast showed no abnormalities, and symptoms had completely resolved 4-5 hours later. Unintended spread of the anesthetic solution along tissue planes seems the most likely explanation for this adverse event. An aberrant course of the facial nerve or connections between the facial and occipital nerves also might have played a role, along with the patient's prone position and the use of a relatively large injection volume of a potent anesthetic. Clinicians should be aware that temporary facial nerve palsy is a possible complication of occipital nerve block.
Occipital osteomylelitis and epidural abscess after occipital nerve block: A case report. [2022]Occipital neuralgia is a paroxysmal jabbing pain in the distribution of the greater or lesser occipital nerves accompanied by diminished sensation in the affected area. Occipital nerve block is a common diagnostic and therapeutic tool used in the course of occipital neuralgia and is considered a safe treatment with few localized adverse events. Occipital nerve block is also indicated for cervicogenic and cluster headache and is often used as a rescue treatment for headaches not responding to conventional therapies. We describe a case of epidural abscess formation 16 days following occipital nerve block in a patient with no underlying medical conditions. This case report emphasizes the importance of strict aseptic technique to reduce infection rates in patients undergoing this procedure, despite the overall safety of occipital nerve block. Clinicians must remain aware of acute and late complications arising postprocedure for the safe practice of this technique.
Ultrasound-guided greater occipital nerve block for patients with occipital headache and short term follow up. [2021]The greater occipital nerve (GON) block has been frequently used for different types of headache, but performed with rough estimates of anatomic landmarks. Our study presents the values of the anatomic parameters and estimates the effectiveness of the ultrasound-guided GON blockade.
Cushing syndrome induced by serial occipital nerve blocks containing corticosteroids. [2013]A patient with chronic daily headaches developed overt signs of Cushing syndrome during treatment with serial occipital nerve block injections. Investigation demonstrated an exogenous source of corticosteroids as the cause of the Cushing syndrome in this patient, thus, implicating the corticosteroid component of the occipital nerve blocks. To our knowledge, this is the first report of Cushing syndrome caused by occipital nerve blockade. Caution is warranted in employing even usual therapeutic doses of synthetic corticosteroids, particularly in long-acting or depot preparations.
Orgasmic headache responsive to greater occipital nerve blockade. [2013]We present a male with headache related to sexual activity. An injection of steroid and local anesthetic combination was applied to the greater occipital nerve of the symptomatic site. The orgasmic headache stopped after the procedure.
Treatment of migraine with occipital nerve blocks using only corticosteroids. [2013]The indications for using steroids when performing occipital nerve blocks (ONBs) are not completely clear. We report a patient with chronic migraines who was allergic to local anesthetics, for whom ONBs using only corticosteroid proved useful. To our knowledge, this is only published case describing the effects of ONBs using only corticosteroid, without local anesthetic.