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CC BY 4.0 · Arq Neuropsiquiatr 2023; 81(08): 734-739
DOI: 10.1055/s-0043-1771494
Original Article

Evaluation of the efficacy of peripheral nerve block alone in episodic and chronic migraine patients

Avaliação da eficácia do bloqueio isolado do nervo periférico em pacientes com enxaquecas episódicas e crônicas

Authors

  • Gokhan Evcili 

    1   University of Health Sciences, Derince Training and Research Hospital, Department of Neurology, Kocaeli, Turkey.

  • Ahmet Yabalak 

    2   Duzce University, Faculty of Medicine, Department of Neurology, Duzce, Turkey.
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Abstract

Background Peripheral nerve block (PNB) is usually performed in patients with migraine who are resistant to treatment with medications.

Objective To compare the efficacy of PNB alone and PNB combined with prophylactic medications in migraine patients.

Method The data on migraine patients who underwent PNB in our clinic between November 2019 and January 2022 were retrospectively reviewed. Blocks of the greater occipital nerve (GON), lesser occipital nerve (LON) and supraorbital nerve (SON) were performed upon admission and in the second week.

Results The study included 116 patients. While 21 out of 39 episodic migraine (EM) patients continued to use prophylactic medications, 18 were followed up with PNB alone. While 49 out of 77 chronic migraine (CM) patients continued to use prophylactic medications, 28 were followed up with PNB alone. Comparison of the admission and second-month data of the patients who only underwent PNB and those who continued the drug treatment together with PNB in both the EM and the CM group showed that the number of days with pain, number of analgesics taken and scores on the Visual Analog Scale (VAS) and the Migraine Disability Assessment (MIDAS) were significantly reduced in both groups (p < 0.01). Comparison of the second-month data of the patients followed up with PNB alone and those followed up with PNB together with prophylactic medications showed that there was no significant difference between the EM and CM patients (p > 0.05).

Conclusion Bilateral GON, LON and SON block with lidocaine injection seems to be an effective treatment on its own, without the need for prophylactic medications, in both EM and CM patients during a two-month follow-up.

Resumo

Antecedentes O bloqueio de nervos periféricos (BNP) geralmente é realizado em pacientes com migrânea resistentes ao tratamento medicamentoso.

Objetivo Comparar a eficácia do BNP isolado e do BNP combinado com medicamentos profiláticos em pacientes com enxaqueca.

Método Os dados de pacientes com enxaqueca submetidos a BNP em nossa clínica entre novembro de 2019 e janeiro de 2022 foram revisados retrospectivamente. Bloqueios do nervo occipital maior (NOM), nervo occipital menor (NOM) e nervo supraorbital (NSO) foram realizados na admissão e na segunda semana.

Resultados O estudo incluiu 116 pacientes. Enquanto 21 dos 39 pacientes com enxaqueca episódica (EE) continuaram a usar medicamentos profiláticos, 18 foram acompanhados apenas com BNP. Enquanto 49 dos 77 pacientes com enxaqueca crônica (EC) continuaram a usar medicamentos profiláticos, 28 foram acompanhados apenas com BNP. A comparação dos dados de admissão e do segundo mês dos pacientes que fizeram apenas BNP e daqueles que continuaram o tratamento medicamentoso junto com BNP, tanto no grupo EE quanto no grupo EC, mostrou que o número de dias com dor, o número de analgésicos tomados e os escores da Escala Visual Analógica (EVA) e da Avaliação da Incapacidade da Enxaqueca (AIE) foram significativamente reduzidos em ambos os grupos (p < 0,01). A comparação dos dados do segundo mês dos pacientes acompanhados apenas com BNP e aqueles acompanhados com BNP juntamente com medicações profiláticas mostrou que não houve diferença significativa entre os pacientes EE e EC (p > 0,05).

Conclusão O bloqueio bilateral de NOM, NOM e NSO com injeção de lidocaína parece ser um tratamento eficaz por si só, sem a necessidade de medicamentos profiláticos, tanto em pacientes EE quanto com EC durante um seguimento de dois meses.

Keywords

Migraine Disorders - Nerve Block - Headache

Palavras-chave

Transtornos de Enxaqueca - Bloqueio Nervoso - Cefaleia

Authors' Contributions

GE: conceptualization, data curation, formal analysis, writing – original draft and writing – review and editing; AY: formal analysis, investigation, writing – original draft and writing – review and editing.




Publication History

Received: 21 June 2022

Accepted: 06 October 2022

Article published online:
03 August 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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