METHOD
A total of 120 chronic migraine patients, aged between 18-65 years,
admitted to the Neurology Outpatient Clinic between January 2017 and
June 2019 were included in the study. The charts of the patients
diagnosed with chronic migraine following the international
classification for headaches were retrospectively reviewed, and previous
data were recorded. The patients who had undergone GON block were
informed about the procedure in detail, and then, their consent was
obtained and archived. The study’s inclusion criterion was to be a
chronic migraine patient who was refractory to treatment and had not
benefited from medical treatment options. Patients were using analgesic,
ergot, triptan derivatives for attack treatment, beta-blockers, calcium
channel blockers, antidepressant derivatives, topiramate
group-antiepileptic treatments, and their combinations for prophylaxis.
Patients with an acute pathology or space-occupying lesion identified by
cranial imaging, pregnant or breastfeeding patients, those with a
history of malignancy, major psychiatric disorders, bleeding diathesis,
those receiving anticoagulant treatment with coumadin and its
derivatives, those allergic to local anesthetics, patients who had
undergone cervical or cranial surgery, patients with neuromuscular
dysfunctions, and those with infection at the procedure site were
excluded from the study.
Patients’ sterilization and emergency response conditions were provided.
After cleaning the intervention area with an antiseptic solution, the
occipital artery located at 1/3 medial to the imaginary line between the
occipital protuberance and mastoid process was palpated. The needle was
inserted and withdrawn when the bone was reached, aspirated to check
whether it was in the artery, and then 1.5 ml of 2% lidocaine was
administered. A 13 mm, 26-gauge (G) was used for the procedure. The
supraorbital and auriculotemporal nerve blocks were performed using the
same technique. Compression was applied after the injection. The patient
was followed-up for approximately 30 minutes. The blockade procedure was
bilaterally performed for six sessions, once a week in the first month
and once a month in the second and third months. The VAS scores, attack
frequency, attack duration, analgesic requirements before the procedure
were recorded together with the 1-month and 3-month data.