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The Efficiency of Peripheral Nerve Blockade and Trigger Point Injections In The Treatment of Chronic Tension-Type Headache

Year 2020, Issue: 2, 304 - 309, 01.06.2020

Mustafa Ceylan Ahmet Yalçın

Abstract

Purpose: Greater and lesser occipital nerve blockade GONB/LONB using local anesthetics with and without corticosteroids, and supraorbital and supratrochlear nerve blockade STNB using local anesthetics and trigger point injections TPI are commonly employed for the treatment of primary and secondary headache disorders. In this study, we aimed to investigate the efficiency of peripheral nerve blockade in the treatment of chronic tension-type headache.Patients and Methods: A total of 174 patients who received GONB and/or STNB with or without TPI between June 2013 and October 2016 were included in this study. The patients were divided into three groups as GONB, GONB+STNB, GONB+STNB+TPI and followed up for four weeks with VAS score. In the GONB alone group, triamcinolone and bupivacaine were used, and in the remaining two groups, only bupivacaine was administered. Results: The mean age of the study population was 43.2±7.2 years. Female dominance was present. There were no statistically significant differences between the three groups regarding age and gender. Furthermore, headache frequency and VAS scores of the groups did not significantly differ before treatment; however, significant differences were observed in both between and within groups after treatment. The response rates were significantly higher 50% and 75% in the last treatment group.Conclusion: In this study, TPI combined with GONB and STNB was superior to GONB+STNB and GONB alone regarding headache frequency. We also found that in all groups, post-treatment VAS scores and headache frequency were lower compared to pretreatment values

Keywords

Chronic tension-type headache Peripheral nerve blockade Greater Occipital Nerve Block Supratrochlear Nerve Block

References

  • Stovner Lj, Hagen K, Jensen R, Katsarava Z, Lipton R, Scher A, et al. The global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia 2007;27:193-210. [CrossRef]
  • Krishnan A, Silver N. Headache (chronic tension-type). BMJ Clin Evid 2009 Jul 22;2009. pii: 1205.
  • Rollnik J.D, Tanneberger O, Schubert M., Schneider U, Dengler R. Treatment of tension-type headache with botulinum toxin type A: A double blind, placebo-controlled study. Headache 2000;40:300–5.
  • Leinisch-Dahlke E, Jürgens T, Bogdahn U, Jakob W, May A. Greater occipital nerve block is ineffective in chronic tension type headache. Cephalalgia 2005;25:704-8. [CrossRef]
  • Puledda F, Goadsby PJ, Prabhakar P. Treatment of disabling headache with greater occipital nerve injections in a large population of childhood and adolescent patients: a service evaluation. J Headache Pain 2018;16;19:5. [CrossRef]
  • Goadsby PJ, Knight YE, Hoskin KL. Stimulation of the greater occipital nerve increases metabolic activity in the trigeminal nucleus caudalis and cervical dorsal horn of the cat. Pain 1997; 71:23–8.
  • Levin M. Nerve blocks in the treatment of headache. Neurotherapeutics 2010;7:197-203. [CrossRef]
  • Anthony M. Headache and the greater occipital nerve. Clin Neurol Neurosurg 1992;94:297–301.
  • Bovim G, Sand T. Cervicogenic headache, migraine without aura and tension-type headache. Diagnostic blockade of greater occipital and supra-orbital nerves. Pain 1992;51:43-8.
  • Inan N, Inan LE, Coşkun Ö, Tunç T, Ilhan M. Effectiveness of Greater Occipital Nerve Blocks in Migraine Prophylaxis. Noro Psikiyatr Ars. 2016;53:45-8. [CrossRef]
  • Inan LE, Inan N, Karadaş Ö, Gül HL, Erdemoğlu AK, Türkel Y, et al. Greater occipital nerve blockade for the treatment of chronic migraine: a randomized, multicenter, double-blind, and placebo- controlled study. Acta Neurol Scand. 2015;132:270-7. [CrossRef]
  • Karadas O, Inan LE, Ulas U, Odabasi Z. Efficacy of local lidocaine application on anxiety and depression and its curative effect on patients withchronic tension-type headache. Eur Neurol. 2013;70:95- 101. [CrossRef]
  • Karadas O, Gul HL, Inan LE. Lidocaine injection of pericranial myofascial trigger points in the treatment of frequent episodic tension-type headache. J Headache Pain 2013;14:44. [CrossRef]
  • Schwartz BS, Stewart WF, Simon D, Lipton RB.Epidemiology of tension-type headache. JAMA. 1998;279:381-3.
  • Lenaerts ME. Burden of tension-type headache. Curr Pain Headache Rep. 2006;10:459-62.
  • Schwartz BS, Stewart WF, Lipton RB. Lost workdays and decreased work effectiveness associated with headache in the workplace. J Occup Environ Med. 1997;39:320-7.
  • Burstein R, Yamamura H, Malick A, Strassman AM. Chemical stimulation of the intracranial dura induces enhanced responses to facial stimulation in brain stem trigeminal neurons. J Neurophysiol 1998;79:964–82. [CrossRef]
  • Schepelmann K, Ebersberger A, Pawlak M, Oppmann M, Messlinger K. Response properties of trigeminal brain stem neurons with input from dura mater encephali in the rat. Neuroscience 1999; 90:543–54.
  • Pfaller K, Arvidsson H. Central distribution of trigeminal and upper cervical primary afferents by anterograde transport of horseradish peroxidase conjugated to wheat germ agglutinin. J Comp Neurol 1988; 268:91–108. [CrossRef]
  • Goadsby PJ. The pathophysiology of headache. In: Silberstein SD, Lipton RB, Dalessio DJ, editors. Wolff’s Headache and Other Head Pain, 7th edn. Oxford: Oxford University Press, 2001:57–72.
  • Bartsch T, Goadsby PJ. Stimulation of the greater occipital nerve induces increased central excitability of dural afferent input. Brain 2002; 125:1496–509.
  • Kerr RW. A mechanism to account for frontal headache in cases of posterior fossa tumours. Neurosurgery 1961;18:605–9. [CrossRef]
  • Bartsch T, Goadsby PJ. Increased responses in trigeminocervical nociceptive neurons to cervical input after stimulation of the dura mater. Brain 2003; 126:1801–13. [CrossRef]
  • Ashkenazi A, Young WB. The effects of greater occipital nerve block and trigger point injection on brush allodynia and pain in migraine. Headache 2005;45:350–4. [CrossRef]
  • Peres MF, Stiles MA, Siow HC, Rozen TD, Young WB, Silberstein SD. Greater occipital nerve blockade for cluster headache. Cephalalgia 2002;22:520–2. [CrossRef]
  • Matute E. Bilateral greater occipital nerve block for post-dural puncture headache. Anaesthesia 2008;63:557–8. [CrossRef]
  • Weatherall MW. Idiopathic trigeminal neuropathy may respond to greater occipital nerve injection. Cephalalgia 2008;28:664–6. [CrossRef]
  • Caputi CA, Firetto V. Therapeutic blockade of greater occipital and supraorbital nerves in migraine patients. Headache 1997;37:174–9.
  • Ashkenazi A, Blumenfeld A, Napchan U, Narouze S, Grosberg B, Nett R, et al. Interventional Procedures Special Interest Section of the American. Peripheral nerve blocks and trigger point injections in headache management – a systematic review and suggestions for future research. Headache 2010; 50:943-52. [CrossRef]
  • Simons DG, Travell JG, Simons LS. Myofascial Pain and Dysfunction: The Trigger Point Manual, Vol. 1, 2nd edn, Upper Half of Body. Baltimore: Lippincott Williams &Wilkins; 1999.
  • Sorrell MR. The physical examination of migraine. Curr Pain Headache Rep. 2006;10:350-4.
  • Simons DG, Travell JG, Simons LS. Myofascial Pain and Dysfunction: The Trigger Point Manual, Vol. 1, 2nd edn, Upper Half of Body. Baltimore: Lippincott Williams &Wilkins; 1999. Ge HY, Fernandez- de-Las-Penas C, Yue SW. Myofascial trigger points: Spontaneous electrical activity and its consequences for pain induction and propagation. Chin Med. 2011;6:13.
  • Shah JP, Phillips TM, Danoff JV, Gerber LH. An in vivo microanalytical technique for measuring the local biochemical milieu of human skeletal muscle. J Appl Physiol (1985). 2005;99:1977-84. [CrossRef]
  • Bendtsen L. Central sensitization in tension-type headache possible pathophysiological mechanisms. Cephalalgia 2000; 20:486–508. [CrossRef]
  • Ashina M. Neurobiology of chronic tension-type headache. Cephalalgia 2004; 24:161–72. [CrossRef]
  • Parelson HN. Occipital nerve tenderness. A sign of headache. South Med J 1947; 40:653–5.
  • Fernandez-de-Las-Penas C, Alonso-Blanco C, Cuadrado ML, Gerwin RD, Pareja JA. Myofascial trigger points and their relationship to headache clinical parameters in chronic tension-type headache. Headache 2006;46:1264-72. [CrossRef]
  • Calandre EP, Hidalgo J, Garcia-Leiva JM, Rico-Villademoros F. Trigger point evaluation in migraine patients: An indication of peripheral sensitization linked to migraine predisposition? Eur J Neurol. 2006;13:244-9. [CrossRef]
  • Calandre EP, Hidalgo J, Garcia-Leiva JM, Rico-Villademoros F, Delgado- Rodriguez A. Myofascial trigger points in cluster headachepatients: A case series. Head Face Med. 2008;4:32. [CrossRef]
  • Erdemoglu A.K, Varlibas A. The long-term efficacy and safety of botulinum toxin in refractory chronic tension-type headache. J. Headache Pain 2007;8:294–300. [CrossRef]

KRONİK GERİLİM TİPİ BAŞ AĞRISI TEDAVİSİNDE PERİFERİK SİNİR BLOKAJI VE TETİK NOKTA ENJEKSIYONLARININ ETKİNLİĞİ

Year 2020, Issue: 2, 304 - 309, 01.06.2020

Mustafa Ceylan Ahmet Yalçın

Abstract

Amaç: Lokal anestezik madde tek başına veya kortikosteroid ile kombine yapılan büyük veya küçük oksipital sinir blokajları GONB/LONB , lokal anestezik madde ile yapılan supraorbital sinir blokajı SONB veya supratroklear sinir blokajları STNB gibi periferik sinir blokajı uygulamaları ve tetik nokta enjeksiyonları TPI primer veya sekonder baş ağrıları tedavilerinde kullanılabilir. Çalışmamızda bu uygulamaların kronik gerilim tipi baş ağrısında etkinliğini araştırmayı amaçladık.Hastalar ve Yöntemler: Haziran 2013 ile Ekim 2016 tarihleri arasında kronik gerilim tipi baş ağrısı tanısıyla GONB, STNB ve TPI yapılan 174 hasta belirlenen gruplara ayrıldı ve enjeksiyonun 4 hafta öncesi ve 4 hafta sonrası takiplerinde VAS ve ağrı frekansları retrospektif karşılaştırıldı. Birinci grup sadece GONB, ikinci grup GONB+STNB ve üçüncü grup aynı anda üç uygulamanında yapıldığı hastalardan oluşturuldu. GONB bupivakain ve triamsinalon ile diğer uygulamalar bupivakain ile yapıldı. Bulgular: Hastaların yaş ortalaması 43.2±7.2, kadın cinsiyet biraz daha fazla tespit edildi. Her üç grup arasında cinsiyet ve yaş ortalamaları arasında istatistiksel fark tespit edilmedi. Gruplar arasında tedavi öncesi ağrı sıklığı ve VAS değerleri arasında istatistiksel fark yok iken, tedavi sonrası bu parametreler arasında grupların kendi içinde ve arasında anlamlı fark tespit edildi. Grup üçte %50 ve %75 yanıt oranlarında anlamlı farklılık tespit edildi.Sonuç: Çalışmada, STNB + GONB ile TPI’nin frekans açısından tek başına STNB+ GONB kombinasyonu veya GONB’ye kıyasla daha iyi sonuçlar verdiğini tespit ettik. Ayrıca tanımlanan tüm enjeksiyon yöntemlerinin etkili olduğunu ve tedaviden sonra VAS skorunu ve baş ağrısı sıklığını azalttığını tespit ettik

Keywords

Kronik gerilim tipi baş ağrısı Periferik Sinir Blokajı Büyük Oksipital Sinir Blokajı Supratkroklear Sinir Blokajı Tetik Nokta Enjeksiyonu

References

  • Stovner Lj, Hagen K, Jensen R, Katsarava Z, Lipton R, Scher A, et al. The global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia 2007;27:193-210. [CrossRef]
  • Krishnan A, Silver N. Headache (chronic tension-type). BMJ Clin Evid 2009 Jul 22;2009. pii: 1205.
  • Rollnik J.D, Tanneberger O, Schubert M., Schneider U, Dengler R. Treatment of tension-type headache with botulinum toxin type A: A double blind, placebo-controlled study. Headache 2000;40:300–5.
  • Leinisch-Dahlke E, Jürgens T, Bogdahn U, Jakob W, May A. Greater occipital nerve block is ineffective in chronic tension type headache. Cephalalgia 2005;25:704-8. [CrossRef]
  • Puledda F, Goadsby PJ, Prabhakar P. Treatment of disabling headache with greater occipital nerve injections in a large population of childhood and adolescent patients: a service evaluation. J Headache Pain 2018;16;19:5. [CrossRef]
  • Goadsby PJ, Knight YE, Hoskin KL. Stimulation of the greater occipital nerve increases metabolic activity in the trigeminal nucleus caudalis and cervical dorsal horn of the cat. Pain 1997; 71:23–8.
  • Levin M. Nerve blocks in the treatment of headache. Neurotherapeutics 2010;7:197-203. [CrossRef]
  • Anthony M. Headache and the greater occipital nerve. Clin Neurol Neurosurg 1992;94:297–301.
  • Bovim G, Sand T. Cervicogenic headache, migraine without aura and tension-type headache. Diagnostic blockade of greater occipital and supra-orbital nerves. Pain 1992;51:43-8.
  • Inan N, Inan LE, Coşkun Ö, Tunç T, Ilhan M. Effectiveness of Greater Occipital Nerve Blocks in Migraine Prophylaxis. Noro Psikiyatr Ars. 2016;53:45-8. [CrossRef]
  • Inan LE, Inan N, Karadaş Ö, Gül HL, Erdemoğlu AK, Türkel Y, et al. Greater occipital nerve blockade for the treatment of chronic migraine: a randomized, multicenter, double-blind, and placebo- controlled study. Acta Neurol Scand. 2015;132:270-7. [CrossRef]
  • Karadas O, Inan LE, Ulas U, Odabasi Z. Efficacy of local lidocaine application on anxiety and depression and its curative effect on patients withchronic tension-type headache. Eur Neurol. 2013;70:95- 101. [CrossRef]
  • Karadas O, Gul HL, Inan LE. Lidocaine injection of pericranial myofascial trigger points in the treatment of frequent episodic tension-type headache. J Headache Pain 2013;14:44. [CrossRef]
  • Schwartz BS, Stewart WF, Simon D, Lipton RB.Epidemiology of tension-type headache. JAMA. 1998;279:381-3.
  • Lenaerts ME. Burden of tension-type headache. Curr Pain Headache Rep. 2006;10:459-62.
  • Schwartz BS, Stewart WF, Lipton RB. Lost workdays and decreased work effectiveness associated with headache in the workplace. J Occup Environ Med. 1997;39:320-7.
  • Burstein R, Yamamura H, Malick A, Strassman AM. Chemical stimulation of the intracranial dura induces enhanced responses to facial stimulation in brain stem trigeminal neurons. J Neurophysiol 1998;79:964–82. [CrossRef]
  • Schepelmann K, Ebersberger A, Pawlak M, Oppmann M, Messlinger K. Response properties of trigeminal brain stem neurons with input from dura mater encephali in the rat. Neuroscience 1999; 90:543–54.
  • Pfaller K, Arvidsson H. Central distribution of trigeminal and upper cervical primary afferents by anterograde transport of horseradish peroxidase conjugated to wheat germ agglutinin. J Comp Neurol 1988; 268:91–108. [CrossRef]
  • Goadsby PJ. The pathophysiology of headache. In: Silberstein SD, Lipton RB, Dalessio DJ, editors. Wolff’s Headache and Other Head Pain, 7th edn. Oxford: Oxford University Press, 2001:57–72.
  • Bartsch T, Goadsby PJ. Stimulation of the greater occipital nerve induces increased central excitability of dural afferent input. Brain 2002; 125:1496–509.
  • Kerr RW. A mechanism to account for frontal headache in cases of posterior fossa tumours. Neurosurgery 1961;18:605–9. [CrossRef]
  • Bartsch T, Goadsby PJ. Increased responses in trigeminocervical nociceptive neurons to cervical input after stimulation of the dura mater. Brain 2003; 126:1801–13. [CrossRef]
  • Ashkenazi A, Young WB. The effects of greater occipital nerve block and trigger point injection on brush allodynia and pain in migraine. Headache 2005;45:350–4. [CrossRef]
  • Peres MF, Stiles MA, Siow HC, Rozen TD, Young WB, Silberstein SD. Greater occipital nerve blockade for cluster headache. Cephalalgia 2002;22:520–2. [CrossRef]
  • Matute E. Bilateral greater occipital nerve block for post-dural puncture headache. Anaesthesia 2008;63:557–8. [CrossRef]
  • Weatherall MW. Idiopathic trigeminal neuropathy may respond to greater occipital nerve injection. Cephalalgia 2008;28:664–6. [CrossRef]
  • Caputi CA, Firetto V. Therapeutic blockade of greater occipital and supraorbital nerves in migraine patients. Headache 1997;37:174–9.
  • Ashkenazi A, Blumenfeld A, Napchan U, Narouze S, Grosberg B, Nett R, et al. Interventional Procedures Special Interest Section of the American. Peripheral nerve blocks and trigger point injections in headache management – a systematic review and suggestions for future research. Headache 2010; 50:943-52. [CrossRef]
  • Simons DG, Travell JG, Simons LS. Myofascial Pain and Dysfunction: The Trigger Point Manual, Vol. 1, 2nd edn, Upper Half of Body. Baltimore: Lippincott Williams &Wilkins; 1999.
  • Sorrell MR. The physical examination of migraine. Curr Pain Headache Rep. 2006;10:350-4.
  • Simons DG, Travell JG, Simons LS. Myofascial Pain and Dysfunction: The Trigger Point Manual, Vol. 1, 2nd edn, Upper Half of Body. Baltimore: Lippincott Williams &Wilkins; 1999. Ge HY, Fernandez- de-Las-Penas C, Yue SW. Myofascial trigger points: Spontaneous electrical activity and its consequences for pain induction and propagation. Chin Med. 2011;6:13.
  • Shah JP, Phillips TM, Danoff JV, Gerber LH. An in vivo microanalytical technique for measuring the local biochemical milieu of human skeletal muscle. J Appl Physiol (1985). 2005;99:1977-84. [CrossRef]
  • Bendtsen L. Central sensitization in tension-type headache possible pathophysiological mechanisms. Cephalalgia 2000; 20:486–508. [CrossRef]
  • Ashina M. Neurobiology of chronic tension-type headache. Cephalalgia 2004; 24:161–72. [CrossRef]
  • Parelson HN. Occipital nerve tenderness. A sign of headache. South Med J 1947; 40:653–5.
  • Fernandez-de-Las-Penas C, Alonso-Blanco C, Cuadrado ML, Gerwin RD, Pareja JA. Myofascial trigger points and their relationship to headache clinical parameters in chronic tension-type headache. Headache 2006;46:1264-72. [CrossRef]
  • Calandre EP, Hidalgo J, Garcia-Leiva JM, Rico-Villademoros F. Trigger point evaluation in migraine patients: An indication of peripheral sensitization linked to migraine predisposition? Eur J Neurol. 2006;13:244-9. [CrossRef]
  • Calandre EP, Hidalgo J, Garcia-Leiva JM, Rico-Villademoros F, Delgado- Rodriguez A. Myofascial trigger points in cluster headachepatients: A case series. Head Face Med. 2008;4:32. [CrossRef]
  • Erdemoglu A.K, Varlibas A. The long-term efficacy and safety of botulinum toxin in refractory chronic tension-type headache. J. Headache Pain 2007;8:294–300. [CrossRef]
There are 40 citations in total.

Details

Primary Language English
Journal Section Research Article
Authors

Mustafa Ceylan

Ahmet Yalçın

Publication Date June 1, 2020
Published in Issue Year 2020Issue: 2

Cite

EndNote Ceylan M, Yalçın A (June 1, 2020) The Efficiency of Peripheral Nerve Blockade and Trigger Point Injections In The Treatment of Chronic Tension-Type Headache. Acıbadem Üniversitesi Sağlık Bilimleri Dergisi 2 304–309.