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Greater occipital nerve block using local anaesthetics alone or with triamcinolone for transformed migraine: a randomised comparative study.

Author(s): Ashkenazi A, Matro R, Shaw JW, Abbas MA, Silberstein SD

Affiliation(s): Department of Neurology, Thomas Jefferson University, 111 South 11th Street, Suite 8130, Philadelphia, PA 19107, USA. avi.ashkenazi@jefferson.edu

Publication date & source: 2008-04, J Neurol Neurosurg Psychiatry., 79(4):415-7. Epub 2007 Aug 6.

Publication type: Comparative Study; Randomized Controlled Trial

OBJECTIVE: To determine whether adding triamcinolone to local anaesthetics increased the efficacy of greater occipital nerve block (GONB) and trigger-point injections (TPIs) for transformed migraine (TM). METHODS: Patients with TM were randomised to receive GONB and TPIs using lidocaine 2% and bupivacaine 0.5% + either saline or triamcinolone 40 mg. We assessed the severity of headache and associated symptoms before and 20 minutes after injection. Patients documented headache and severity of associated symptoms for 4 weeks after injections. Changes in symptom severity were compared between the two groups. RESULTS: Thirty-seven patients were included. Twenty minutes after injection, mean headache severity decreased by 3.2 points in group A (p<0.01) and by 3.1 points in group B (p<0.01). Mean neck pain severity decreased by 1.5 points in group A (p<0.01) and by 1.7 points in group B (p<0.01). Mean duration of being headache-free was 2.7+/-3.8 days in group A and 1.0+/-1.1 days in group B (p = 0.67). None of the outcome measures differed significantly between the two groups. Both treatments were well tolerated. CONCLUSIONS: Adding triamcinolone to local anaesthetics when performing GONB and TPIs was not associated with improved outcome in this sample of patients with TM.

Page last updated: 2008-06-22

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