Greater occipital and supraorbital nerve blockade for the preventive treatment of migraine: a single-blind, randomized, placebo-controlled study

<b>Objective:</b> Nerve injections have been used for the acute and preventive treatment of migraine in recent decades. Most of these injections focused on greater occipital nerve (GON) blockade. However, few studies were placebo controlled, and only a few of them investigated GON and supraorbital nerve (SON) blockade together. This study aimed to evaluate the efficacy of GON and SON blockade with local anesthetics for the preventive treatment of migraine without aura. <b>Methods:</b> Eighty-seven patients diagnosed with migraine without aura were included in the study. Patients were divided randomly. One group was injected with 1% lidocaine, the other group was injected with 0.9% saline. GON and SON injections were done bilaterally. The injections were repeated weekly for 3 weeks. Patients were followed up for 2 months to assess clinical response. <b>Results:</b> Seventy-one patients completed the study. After 2 months, the number of headache days decreased significantly from 12.8 ± 10.9 to 5.3 ± 7.4, and VAS decreased from 8.3 ± 1.0 to 5.5 ± 1.9 in the blockade group. The number of headache days decreased from 12.4 ± 10.3 to 7.5 ± 7.2 and VAS decreased from 8.2 ± 1.1 to 7.4 ± 1.3 in the placebo group. Response was seen in 65.1% of the patients in the blockade group (65.4% for episodic migraine, 64.7% for chronic migraine) and 28.6% of the patients in the placebo group. The difference was significant. <b>Conclusions:</b> The results suggest that GON and SON blockade with lidocaine was more effective than the placebo in the prophylactic treatment of both episodic and chronic migraine. <b>Trial registration:</b>ClinicalTrials.gov identifier: NCT03435185.

<b>研究目的：</b>近数十年来，神经注射疗法已被用于偏头痛的急性与预防性治疗。此类注射疗法大多聚焦于枕大神经（greater occipital nerve, GON）阻滞。然而，现有研究中采用安慰剂对照的极少，且仅少数研究同时探讨了枕大神经与眶上神经（supraorbital nerve, SON）阻滞的应用效果。本研究旨在评估局部麻醉剂行枕大神经及眶上神经阻滞治疗无先兆偏头痛的临床疗效。
<b>研究方法：</b>本研究共纳入87例确诊为无先兆偏头痛的患者，采用随机分组方案。一组患者接受1%利多卡因注射，另一组接受0.9%生理盐水注射。双侧枕大神经与眶上神经均予以注射，每周注射1次，连续治疗3周。对所有患者进行为期2个月的随访，以评估临床应答情况。
<b>研究结果：</b>最终共有71例患者完成本研究。随访至2个月时，阻滞组患者的头痛日数从12.8±10.9显著降至5.3±7.4，视觉模拟评分（Visual Analogue Scale, VAS）从8.3±1.0降至5.5±1.9；安慰剂组患者的头痛日数从12.4±10.3降至7.5±7.2，视觉模拟评分从8.2±1.1降至7.4±1.3。阻滞组患者的临床应答率为65.1%（其中发作性偏头痛患者应答率为65.4%，慢性偏头痛患者应答率为64.7%），安慰剂组应答率为28.6%，组间差异具有统计学意义。
<b>研究结论：</b>本研究结果显示，相较于安慰剂疗法，采用利多卡因行枕大神经与眶上神经阻滞，对发作性及慢性偏头痛均具备更优的预防性治疗效果。
<b>试验注册：</b>ClinicalTrials.gov 注册号：NCT03435185。