Repetitive GON Blockade for Menstrual Migraine

May 3, 2026 updated by: NAZLI GAMZE BÜLBÜL, Saglik Bilimleri Universitesi

Perimenstrual Repetitive Greater Occipital Nerve Blockade for Menstrual Migraine: A Randomized, Double-Blind, Placebo-Controlled Trial

: The primary objective of this prospective, randomized, double-blind, placebo-controlled clinical trial is to evaluate whether repetitive bilateral greater occipital nerve (GON) blockade administered with a local anesthetic (0.5% bupivacaine) significantly reduces headache severity, attack duration, and the number of pain days in female patients with menstrual migraine compared to a placebo group (normal saline). Patients will receive injections twice a month for three months (seven days before the expected onset of menstruation and on the first day of menstruation).

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Menstrual migraine (MM) is a highly prevalent and challenging migraine subtype triggered by fluctuations in estrogen and progesterone levels, particularly estrogen withdrawal during the perimenstrual period

  • This hormonal withdrawal sensitizes the trigeminovascular system and promotes the release of neuropeptides such as calcitonin gene-related peptide (CGRP)
  • Currently, there are no licensed prophylactic medications specifically developed for MM, making alternative and non-systemic treatments necessary

This study investigates the efficacy of a targeted peripheral neuromodulation approach using bilateral greater occipital nerve (GON) blockade. The underlying clinical rationale is that GON blockade timed to the perimenstrual period can modulate nociceptive transmission at the trigeminocervical complex (TCC) and decrease peripheral nerve excitability, thereby limiting the impact of cyclic hormonal fluctuations on the trigeminovascular system

. In this trial, a Latin square experimental design is utilized to ensure balanced randomization between the active treatment and placebo groups

  • Unlike single-injection protocols, the intervention is specifically synchronized with the patients' menstrual cycles, involving injections twice a month over a three-month period (seven days before menstruation and on the first day of menstruation)
  • By evaluating this specific timing and repetitive protocol, the study aims to establish whether perimenstrual-targeted GON blockade can serve as an effective, non-systemic, short-term prophylactic strategy for patients suffering from this refractory migraine subtype.

Study Type

Interventional

Enrollment (Actual)

48

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Turkey (Türkiye)
    • Istanbul
      • Istanbul, Istanbul, Turkey (Türkiye), 34668
        • Saglik Bilimleri Universitesi

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Diagnosed with pure menstrual migraine or menstrually related migraine according to the International Classification of Headache Disorders, 3rd edition (ICHD-3) diagnostic criteria.
  • A documented history of migraine attacks during the perimenstrual period (between days -2 and +3 relative to the onset of menstruation) in at least two of the last three menstrual cycles.

Exclusion Criteria:

  • Diagnosis of chronic migraine.
  • Presence of an additional primary or secondary headache disorder.
  • Pregnant or lactating.
  • Known hypersensitivity to local anesthetics.
  • Received an occipital nerve blockade within the last three months.
  • Presence of a significant neurological or systemic disease that could affect the outcome evaluation.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Quadruple

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Active Treatment: 0.5% Bupivacaine
Patients receive bilateral greater occipital nerve (GON) blockade using 0.5% bupivacaine. Injections are administered twice a month for three months (seven days before the expected onset of menstruation and on the first day of menstruation).
Drug: 0.5% bupivacaine
Bilateral greater occipital nerve (GON) blockade using a local anesthetic.
Placebo Comparator: Placebo: Normal Saline
Patients receive bilateral greater occipital nerve (GON) blockade using an equivalent volume of normal saline. Injections are administered twice a month for three months, following the same schedule as the active treatment group.
Other: Normal Saline
Bilateral greater occipital nerve (GON) blockade using placebo (normal saline).

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in headache severity evaluated using the Visual Analog Scale (VAS)
Time Frame: Baseline, Month 3, and Month 6
Headache severity measured by VAS.
Baseline, Month 3, and Month 6

Secondary Outcome Measures

Outcome Measure
Time Frame
Change in monthly migraine attack frequency
Time Frame: Baseline, Month 3, and Month 6
Baseline, Month 3, and Month 6
Change in number of headache days per month
Time Frame: Baseline, Month 3, and Month 6
Baseline, Month 3, and Month 6
Change in mean attack duration in hours
Time Frame: Baseline, Month 3, and Month 6
Baseline, Month 3, and Month 6
Change in monthly analgesic consumption
Time Frame: Baseline, Month 3, and Month 6
Baseline, Month 3, and Month 6
Change in Migraine Disability Assessment (MIDAS) scores
Time Frame: Baseline, Month 3, and Month 6
Baseline, Month 3, and Month 6

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Saglik Bilimleri Universitesi

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

October 19, 2024

Primary Completion (Actual)

May 30, 2025

Study Completion (Actual)

November 30, 2025

Study Registration Dates

First Submitted

May 3, 2026

First Submitted That Met QC Criteria

May 3, 2026

First Posted (Actual)

May 8, 2026

Study Record Updates

Last Update Posted (Actual)

May 8, 2026

Last Update Submitted That Met QC Criteria

May 3, 2026

Last Verified

May 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • E66291034-202.3.02-5953

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

YES

IPD Plan Description

The data supporting the findings of this study is available from the corresponding author upon reasonable request.

IPD Sharing Time Frame

Data will become available immediately following the publication of the study results and will remain accessible indefinitely.

IPD Sharing Access Criteria

De-identified individual participant data that underlie the results reported in this article will be shared. Data will be available to researchers who provide a methodologically sound proposal to achieve aims in the approved proposal. Requests should be directed to the corresponding author via email. Access may require signing a data access agreement.

IPD Sharing Supporting Information Type

  • STUDY_PROTOCOL
  • SAP

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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