Ultrasound-guided greater occipital nerve block for patients with occipital headache and short term follow up

Jae Hang Shim, So Young Ko, Mi Rang Bang, Woo Jae Jeon, Sang Yun Cho, Jong Hoon Yeom, Woo Jong Shin, Kyoung Hun Kim, Jae-Chol Shim, Jae Hang Shim, So Young Ko, Mi Rang Bang, Woo Jae Jeon, Sang Yun Cho, Jong Hoon Yeom, Woo Jong Shin, Kyoung Hun Kim, Jae-Chol Shim

Abstract

Background: The greater occipital nerve (GON) block has been frequently used for different types of headache, but performed with rough estimates of anatomic landmarks. Our study presents the values of the anatomic parameters and estimates the effectiveness of the ultrasound-guided GON blockade.

Methods: The GON was detected using ultrasound technique and distance from external occipital protuberance (EOP) to GON, from GON to occipital artery and depth from skin to GON was measured in volunteers. Patients with occipital headache were divided into two groups (ultrasound-guided block: group S, conventional blind block: group B) and GON block was performed. The same parameters were measured on group S and VAS scores were assessed at pretreatment, 1 week and 4 weeks after treatment on both groups.

Results: The GON had distance of 23.1 ± 3.4 mm (right) and 20.5 ± 2.8 mm (left) from EOP to GON. Its depth below the skin was 6.8 ± 1.5 mm (right) and 7.0 ± 1.3 mm (left). The distance from GON to occipital artery was 1.5 ± 0.6 mm (right) and 1.2 ± 0.6 mm (left) in volunteers. Initial VAS score of group S and group B patients were 6.4 ± 0.2 and 6.5 ± 0.2. VAS score of 4 weeks after injection were 2.3 ± 0.2 on group S and 3.8 ± 0.3 on group B (P = 0.0003).

Conclusions: The parameters measured in this study should be useful for GON block and ultrasound-guided blockade is likely to be a more effective technique than blind blockade in occipital headache treatment.

Keywords: Greater occipital nerve block; Occipital headache; Ultrasound; Visual analogue scale.

Figures

Fig. 1
Fig. 1
Ultrasound image of the greater occipital nerve (GON) and the occipital artery (a) of the left side away from the midline (external occipital protuberance; EOP) is seen (A). Fluid accumulation of local anesthetic (thin arrow) is seen around the greater occipital nerve (thick arrows) after injection (B).
Fig. 2
Fig. 2
Comparison of VAS score between the two groups on each time course is seen. Group S (n = 22) defined as patients with ultrasound-guided greater occipital nerve (GON) block and group B (n = 20) as patients with conventional blind block. Two patients were not reached to obtain the VAS score at 4 weeks for group S and so dropped off. *P < 0.05 compared with group B at 4 weeks after treatment. †P < 0.05 compared with pretreatment on both groups. Pre: before greater occipital nerve block, 1 W: 1 week after block, 4 W: 4 weeks after block.

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