A Randomized Trial of Bilateral Greater Occipital Nerve Blocks Versus Ten Peripheral Nerve Blocks for Acute Relief and Prophylaxis of Episodic Migraine
Mayo Clinic
Summary
The purpose of this study is to see how well blocking two to ten of the scalp nerves (that give feeling to the scalp and are painful during migraine headaches) with bupivacaine anesthetic (numbing medication) and low dose methylprednisolone (cortisone-like medicine or steroid) work for treating and preventing migraines. Our hypothesis is that the pain of most episodic migraine headaches can be eliminated and prevented for months by blocking the nerves that give pain sensation during a migraine.
Description
Hypothesis: Multiple peripheral nerve blocks provide more complete acute headache relief and better headache prophylaxis in episodic migraine than greater occipital nerve blocks alone. Aims, purpose, or objectives: The primary endpoint will be pain freedom at 20 minutes after confirmation that all nerve blocks were successful. The secondary endpoints will be 1) headache pain severity \</= 1/10 at 20 minutes, 2) headache pain freedom at 2 hours, 3) sustained pain freedom at 24 hours, 4) time to pain freedom, 5) prophylaxis of future headache frequency and severity during the 12 weeks after PN…
Eligibility
- Age range
- 18+ years
- Sex
- All
- Healthy volunteers
- No
Inclusion Criteria: * Suffering from episodic migraines with and without aura occurring at least four times a month but less than 15 times a month at a severity of 5/10 pain level or greater. * Willing to not start or stop any new medication to treat or prevent migraines during the six months of the trial. * History fits the definition of migraine: * Have a history of episodic headache lasting 4-72 hours with at least 2 of the 4 following: unilateral location, pulsating/throbbing quality, moderate-severe intensity, aggravation by/causing avoidance of routine physical activity, and * Have…
Interventions
- DrugBupivacaine HCl 0.5% Injectable Solution
Will receive 0.5 ml (supratrochlear) to 1.0 ml (supraorbital, auriculotemporal) to 1.25 ml (greater and lesser occipital) for each nerve block. Will receive 0.25 ml or 10 mg methylprednisolone to each greater and lesser occipital nerve in the MPNB arm and 0.5 ml or 20 mg methylprednisolone to both greater occipital nerves in the GONB arm.
- DrugMethylprednisolone 40 MG Injection
Will receive 10 mg (0.25 ml) mixed with 1.25 ml Bupivacaine 0.5% for each greater and lesser occipital nerve block if MPNB group or 20 mg (0.5 ml) methylprednisolone in each GON if GONB group.
Location
- Mayo Clinic in RochesterRochester, Minnesota