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 The needle was inserted and withdrawn when the bone was reached, aspirated to check whether it was in the artery, and then 1.5 ml of 2% lidocaine was administered.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.