259: Efficacy of Greater Occipital Nerve intervention in Managing Chronic Migraine Headache

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic primary headache, Pharmacological treatments

Background and Aims: Chronic migraine causes severe functional disability, often unresponsive to standard pharmacotherapy. (1-3) Ultrasound-guided greater occipital nerve (GON) block provides a focused interventional approach to reduce pain transmission through the trigeminocervical pathway.(4,5) The study aims to evaluate the efficacy of ultrasound-guided unilateral GON intervention in chronic migraine patients.

Methods: In this prospective single-arm pilot study, 38 patients aged 18–65 years (ICHD-3 criteria) received a single ultrasound-guided GON block with 2 mL of 1% lignocaine and 8 mg dexamethasone (total 3 mL). Pain intensity (NRS), migraine frequency, Medication Quantification Scale (MQS), and quality of life (QoL) were assessed at baseline, post-procedure, and 4 weeks. Statistical analysis was done using SPSS v23 with significance at p < 0.05.

Results: Mean NRS reduced from 8.1 ± 1.2 to 2.9 ± 1.4 (p < 0.001). Migraine frequency decreased from 13.8 ± 2.9 to 6.2 ± 2.4 days/month (p < 0.001). MQS dropped by 47% and QoL improved by 38% (p < 0.01). No major adverse events occurred.

Conclusions: A single ultrasound-guided GON intervention significantly reduces pain, migraine frequency, and medication use, improving quality of life with excellent safety.

References: 1. Martelletti P, Katsarava Z, Lampl C, Magis D, Bendtsen L, Negro A, Russell MB, Mitsikostas DD, Jensen RH. Refractory chronic migraine: a consensus statement on clinical definition from the European Headache Federation. J Headache Pain. 2014 Aug 28;15(1):47. doi: 10.1186/1129-2377-15-47. PMID: 25169882; PMCID: PMC4237793.
2. Robbins L. Refractory chronic migraine: long-term follow-up using a refractory rating scale. J Headache Pain. 2012 Apr;13(3):225-9. doi: 10.1007/s10194-012-0423-z. Epub 2012 Feb 25. PMID: 22367626; PMCID: PMC3311833.
3. D'Antona L, Matharu M. Identifying and managing refractory migraine: barriers and opportunities? J Headache Pain. 2019 Aug 23;20(1):89. doi: 10.1186/s10194-019-1040-x. PMID: 31443629; PMCID: PMC6734232.
4. Chowdhury D, Datta D, Mundra A. Role of Greater Occipital Nerve Block in Headache Disorders: A Narrative Review. Neurol India. 2021 Mar-Apr;69(Supplement):S228-S256. doi: 10.4103/0028-3886.315993. PMID: 34003170.
5. Katalinic D, Aleric I, Smolic M, Vcev A. The Role of Occipital Nerve Block for Chronic Migraine Patients: Mechanisms and Management. Ann Indian Acad Neurol. 2023 Nov-Dec;26(6):856-857. doi: 10.4103/aian.aian_470_23. Epub 2023 Aug 18. PMID: 38229628; PMCID: PMC10789404.

Presenting Author: Dr Ganesh Ramaji Nimje
Submitting Author: GANESH RAMAJI NIMJE

Senior Author: Dr Ravi Shankar Sharma

IASP 2026 Global Year theme of Neuropathic Pain: No

• Dr Ravi Shankar Sharma: MD, DM (Pain Medicine) - All India Institute of Medical Sciences, Gorakhpur
• Dr Ajay: MD - All India Institute of Medical Science, Gorakhpur