The role of nerve blocks and botulinum toxin injections in the management of cluster headaches

  title={The role of nerve blocks and botulinum toxin injections in the management of cluster headaches},
  author={Jessica Ailani and William B. Young},
  journal={Current Pain and Headache Reports},
  • J. Ailani, W. Young
  • Published 14 March 2009
  • Medicine, Psychology
  • Current Pain and Headache Reports
Cluster headache (CH) is a primary headache syndrome that is classified with the trigeminal autonomic cephalalgias. CH treatment involves three steps: acute attack management, transitional therapy, and preventive therapy. Greater occipital nerve block has been shown to be an effective alternative bridge therapy to oral steroids in CH. Botulinum toxin type A has recently been studied as a new preventive treatment for patients with chronic CH, with limited success. 
Botulinum Toxin and the Treatment of Headache: A Clinical Review
Parsing head pain is about classifying the common complaints people bring to us, and by attempting to answer old questions, new ones have been raised amongst by this new treatment.
Botulinum toxin and the treatment of headache: A clinical review.
  • A. Finkel
  • Medicine, Psychology
    Toxicon : official journal of the International Society on Toxinology
  • 2015
Ganglion Impar Block With Botulinum Toxin Type A for Chronic Perineal Pain -A Case Report-
A patient who was successfully given ganglion impar block with BoNT-A, considered secondary to its action for muscle relaxation, also affects the release of the neurotransmitters that are involved in pain perception.
The Efficacy of Botulinum Toxin in Cluster Headache: A Systematic Review.
There was low-quality evidence that botulinum toxin was effective in reducing headache frequency and severity by at least 50% and off-label use should be considered in certain cases.
All About Cluster Headaches
According to the International Classification of Headache Disorders (ICHD), cluster headaches are a member of the trigeminal autonomic cephalalgia (TAC) family of headaches [1]. Trigeminal refers to
Sonographic visualization and ultrasound-guided blockade of the greater occipital nerve: a comparison of two selective techniques confirmed by anatomical dissection.
It is confirmed that the GON can be visualized using ultrasound both at the level of the superior nuchal line and C2, superficial to the obliquus capitis inferior muscle, which should allow a more precise blockade of the nerve.
Cefalea en racimos
Designing Studies for Cluster Headache: Lessons Learned
  • M. Bigal
  • Medicine
    Current pain and headache reports
  • 2011


Botulinum toxin type-A therapy in cluster headache: an open study
Evidence is provided that BTX-A may be beneficial as an add-on prophylactic therapy for a limited number of patients with chronic CH and a total cessation of attacks and in 2 patients attack intensity and frequency improved.
[Treatment of vascular pain of the face by methylprednisolone injection into the area of the greater occipital nerve: 16 cases].
Sixteen patients suffering from cluster headache received an injection of 160 mg methylprednisolone into the region of the greater occipital nerve ipsilateral to the pain, when free of headache, and results are not as favourable as those obtained by Anthony, who advocated this technique.
Greater occipital nerve block for migraine and other headaches: Is it useful?
Little evidence exists for the efficacy of GON block in migraine treatment, and controlled studies are needed to better assess the role of Gon block in the treatment of migraine and other headaches.
Antiepileptic Drugs for the Treatment of Chronic and Episodic Cluster Headache: A Review
Newly available preliminary clinical trial data evaluating antiepileptic drugs for the prevention of cluster headache suggest that these agents may be effective and that further evaluation in randomized, placebo‐controlled trials is warranted.
Greater Occipital Nerve Blockade for Cluster Headache
Greater occipital nerve blockade is a therapeutic option for the transitional treatment of cluster headache and was well tolerated with no adverse events.
Expert Opinion: Greater Occipital Nerve and Other Anesthetic Injections for Primary Headache Disorders
In his 1948 headache book, Harold Wolff described 3 types of occipital neuralgia, which are characterized by a long-lasting, more or less sustained aching of low or moderate intensity, and is occasionally preceded by visual scotomas and paresthesias of the extremities.
Topiramate in the Prophylactic Treatment of Cluster Headache
Evaluation of the effectiveness of topiramate in a group of patients with refractory episodic or chronic cluster headache found it to be effective in both the prevention and treatment of cluster headache.
Evidence for Antinociceptive Activity of Botulinum Toxin Type A in Pain Management
  • K. Aoki
  • Biology, Medicine
  • 2003
Current data points to an antinociceptive effect of botulinum toxin type A that is separate from its neuromuscular activity, which is similar to that reported to block substance P release using in vitro culture systems.
Melatonin in the Preventive Treatment of Chronic Cluster Headache
  • M. Peres, T. Rozen
  • Medicine, Psychology
    Cephalalgia : an international journal of headache
  • 2001
It is demonstrated that melatonin could rapidly alleviate cluster attacks, but only in episodic cluster patients, and reported two chronic cluster headache patients who had both daytime and nocturnal attacks that were alleviated with melatonin.