Abstract Details

Title One and Done: A Case Series of Large Volume Occipital Nerve Blocks for the Treatment of Occipital Neuralgia

Topic Headache

Presentation(s) P5 - Poster Session 5 (5:30 PM-6:30 PM)

Poster/Presentation
Number 13-007

Objective To evaluate long-term outcomes of patients who received large volume occipital nerve blocks with steroids (NB) for the treatment of occipital neuralgia (ON).

Background A response to NB is part of the diagnostic criteria for ON. As such, NB have been widely used for both diagnostic and therapeutic purposes for patients with ON. There is high variability in terms of technique, medications, and doses when performing these injections. As such, the duration of benefit can be variable.

Design/Methods This single center, IRB approved, retrospective chart review study examined the efficacy of NB performed on patients who were diagnosed with probable ON. Probable ON was defined as meeting criteria for ON except for response to NB, which was to be determined. The NB consisted of 5.5 cc 0.75% bupivacaine and 0.5 cc kenalog (20mg) per side. Response to treatment was assessed during routine follow-up appointments.

Results 119 consecutive patients were diagnosed with probable ON, and 41 consented to treatment with NB. The patients were predominantly female (34:7). The mean age was 45.56 and mean BMI was 28.19. Six patients had isolated probable ON while 35 had a co-existing primary headache disorder. All subjects had a remission of ON pain with a duration range of 4-840 days and a mean of 206.95 days. For many patients, the pain had not returned by their last follow-up, so even these duration recordings underestimate the actual duration of benefit. No long term side effects were noted after a single NB.

Conclusions

NB are frequently utilized to diagnose and treat ON, but consideration should be given to utilizing larger volumes and steroids. A possible mechanism of action is the pressure generated by injecting the solution is causing an expansion of tissue planes, which may cause nerve decompression, which in some cases lead to a long-term/indefinite resolution of ON pain.

Authors/Disclosures
Paul G. Mathew, MD, DNBPAS, FAHS, FACSM, FAAN (Harvard Medical School/Mass General Brigham/Atrius Health) PRESENTER	Dr. Mathew has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Abbvie/Allergan. Dr. Mathew has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Lilly. Dr. Mathew has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amgen. Dr. Mathew has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Biohaven/Pfizer. Dr. Mathew has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Theranica. Dr. Mathew has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Impel. Dr. Mathew has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Upsher Smith. Dr. Mathew has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Linpharma. Dr. Mathew has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Abbvie.
Umer Najib, MD, FAAN (West Virginia University Hospitals)	Dr. Najib has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Pfizer. Dr. Najib has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Lundbeck . Dr. Najib has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Abbvie . The institution of Dr. Najib has received research support from Eli Lilly. The institution of Dr. Najib has received research support from Abbvie.
Shaoleen Khaled	No disclosure on file
Regina Krel, MD (Hackensack University Medical Group)	No disclosure on file

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