Greater occipital nerve blocks in the treatment of refractory chronic migraine: An observational report of nine cases

AIM To report the effects of greater occipital nerve(GON) blocks on refractory chronic migraine headache.METHODS Nine patients who were receiving the conventionally accepted preventive therapies underwent treatment with repeated GON block to control chronic migraine resistant to other treatments. GON blocking with lidocaine and normal saline mixture was administered by the same physician at hospital once a month(for three times in total). Patients were assessed before the injection and every month thereafter for pain frequency and severity, number of times analgesics were used and any appearant side effects during a 6 mo follow-up.RESULTS Eight of nine patients reported a marked decrease in frequency and severity of migraine attacks in comparison to their baseline symptoms; one reported no significant change(not more than 50%) from baseline and did not accept the second injection. GON block resulted in considerable reduction in pain frequency and severity and need to use analgesics up to three months after the injection in the present cases. The patients did not report any adverse effects. CONCLUSION Hereby we noticed a remarkable success with refractory chronic migraine patients. We believe that this intervention can result in rapid relief of pain with the effects lasting for perhaps several weeks or even months. Further controlled clinical trials are warranted to evaluate the effect of GON block in the treatment of refractory migraine cases.

Comparison of Botox^(█) or Prosigne^(█) and Facial Nerve Blockade as Adjuvant in Chronic Migraine

Background: The treatments suggested for chronic migraine (CM) include: 1) intramuscular (im) botulinum toxin (BTX) every 12 weeks, and 2) blockade of peripheral nerves of the head. The present study evaluated the efficacy of facial nerve blockade in combination with a single administration of different low BTX. Methods: Forty patients with CM submitted to unilateral facial nerve blockade (supraorbital, supratrochlear and auriculotemporal) were divided into 4 randomized groups in a double-blind manner in order to receiveim, after 7 days: 25 IU Botox®(Botox group), 25 IU Prosigne®(25-Pro group), 33.3 IU Prosigne®(33-Pro group) or saline (control group), with the dose divided for application to 10 sites in the frontal and bilateral temporal regions. Analgesia and adverse effects were evaluated: 1) before blockade of the facial nerves and 2) 4 weeks, 3) 8 weeks and 4) 12 weeks after BTX-A or saline application (HC clinical trial no. 12465). Results: Botox®(25 IU) or Prosigne®(33.3 IU) resulted in at least seven-day intervals between headache attacks associated with 70% reduction in frequency and intensity of crises over 12 weeks (P ®resulted in 8 weeks of analgesia. The conversion factor between Botox®and Prosigne®was 1:1.3. Conclusions: Im application of Botox®(25 IU) or Prosigne®(33.3 IU) one week after nerve blockade on the painful side was equally effective for 12 weeks in patients with chronic daily headache, with the conversion factor between Botox®and Prosigne®being 1:1.3.

The observation on different effectiveness between the embedding needle therapy and medication in the preventative treatment of chronic migraine

Objective: To evaluate the therapeutic effects of the embedding needle therapy in the preventative treatment of chronic migraine.Methods: A total of 36 patients with chronic migraine were divided into an embedding needle therapy group and a flunarizine group according to random number table, 18 cases in each group. In the embedding needle therapy group, the thumb-tack needles were used at Sizhúkōng(丝竹空TE 23), Hànyàn(颔厌GB 4), Wángǔ(完骨GB 12) and Cuánzhú(攒竹BL 2) and the needles were embedded for 24 h. The embedding needle therapy was given three times a week. In the flunarizine group, flunarizine was prescribed, 10 mg a day. Separately, at the end of the 4-week treatment and in 4 weeks of the follow-up, the number of days of headache attack per month(days/month) and the headache duration(hours/month)in the cases with moderate to severe headache were observed in the two groups.Results: The number of days of headache attack in the cases with moderate to severe headache was reduced after treatment as compared with the number before treatment in the two groups. The headache duration was reduced obviously after treatment in the cases of moderate to severe headache in the two groups. In the 4-week follow-up, all the indexes were still reduced as compared with the indexes before treatment, indicating the significant differences in the two groups(both P < 0.05). In the embedding needle therapy group, at the end of the 4-week treatment and in 4 weeks of the follow-up, the number of days of headache attack per month was(8.1 ± 2.4) days and(7.2 ± 1.6) days separately, which were significant difference as compared with(9.7 ± 2.3) days and(8.9 ± 1.4) days in the flunarizine group(both P < 0.05). Regarding the headache duration, at the end of the 4-week treatment and in 4 weeks of the follow-up, it was(105.6 ± 10.5) h/month and(92.1 ± 7.2) h/month respectively in the embedding needle therapy group, indicating the significant differences as compared with(135.4 ± 8.9) h and(116.1 ± 8.2) h in the flunarizine group respectively(both P < 0.05).Conclusion: The 4-week treatment with the embedding needle therapy obviously reduces the number of days of headache attack and the headache duration, presents the preventative effects in the patients with chronic migraine.

Regional volume changes of the brain in migraine chronification

The pathophysiology of migraine is complex.Neuroimaging studies reveal functional and structural changes in the brains of migraine patients.We sought to explore regional volume differences in intracranial structures in patients with episodic and chronic migraine.Sixteen episodic migraine patients,16 chronic migraine patients,and 24 normal controls were recruited and underwent 3.0 T MRI scanning.The volumes of 142 brain regions were calculated by an automatic volumetric algorithm and compared with clinical variables.Results demonstrated that the volumes of specific regions in the frontal and occipital lobes,and the right putamen,were increased and the volume of the fourth ventricle was decreased in the episodic migraine patients compared with controls.The volumes of the left basal forebrain,optic chiasm,and,the fourth ventricle were decreased in the chronic migraine patients,while the occipital cortex and the right putamen were larger.Compared to episodic migraine patiants,chronic migraine patients displayed larger left thalamus and smaller frontal regions.Correlation analysis showed that headache frequency was negatively correlated with the volume of the right frontal pole,right lateral orbital gyrus,and medial frontal lobes and positively correlated with the volume of the left thalamus.The sleep disturbance score was negatively correlated with the volume of the left basal forebrain.This suggests that migraine patients have structural changes in regions associated with pain processing and modulation,affective and cognitive processing,and visual perception.The remodeling of selective intracranial structures may be involved in migraine attacks.This study was approved by the Ethics Committee of Chinese PLA General Hospital(approval No.S2018-027-02)on May 31,2018.

The Objective Assessment of Event-Related Potentials:An Influence of Chronic Pain on ERP Parameters

The article presents an original method for the automatic assessment of the quality of event-related potentials(ERPs),based on the calculation of the coefficientε,which describes the compliance of recorded ERPs with some statistically significant parameters.This method was used to analyze the neuropsychological EEG monitoring of patients suffering from migraines.The frequency of migraine attacks was correlated with the spatial distribution of the coefficientsε,calculated for EEG channels.More than 15 migraine attacks per month was accompanied by an increase in calculated values in the occipital region.Patients with infrequent migraines exhibited maximum quality in the frontal areas.The automatic analysis of spatial maps of the coefficientεdemonstrated a statistically significant difference between the two analyzed groups with different means of migraine attack numbers per month.