Observational Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 16, 2016; 4(10): 323-327
Published online Oct 16, 2016. doi: 10.12998/wjcc.v4.i10.323
Greater occipital nerve blocks in the treatment of refractory chronic migraine: An observational report of nine cases
Abdulkadir Koçer
Abdulkadir Koçer, Department of Neurology, Göztepe Teaching Hospital, Istanbul Medeniyet University Medical Faculty, 34100 Istanbul, Turkey
Author contributions: Koçer A planned and wrote the paper.
Institutional review board statement: No need.
Informed consent statement: All study participants provided informed written consent prior to injections.
Conflict-of-interest statement: Nothing to be declared.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Abdulkadir Koçer, MD, MSc, Profesor of Neurology, Department of Neurology, Göztepe Teaching Hospital, Istanbul Medeniyet University Medical Faculty, Erkin Street, Number 4, 34100 Istanbul, Turkey. abdulkadirkocer@yahoo.com
Telephone: +90-50-54262828 Fax: +90-21-65709050
Received: April 29, 2016
Peer-review started: April 29, 2016
First decision: June 17, 2016
Revised: July 21, 2016
Accepted: August 6, 2016
Article in press: August 8, 2016
Published online: October 16, 2016

To report the effects of greater occipital nerve (GON) blocks on refractory chronic migraine headache.


Nine patients who were receiving the conventionally accepted preventive therapies underwent treatment with repeated GON block to control chronic migraine resistant to other treatments. GON blocking with lidocaine and normal saline mixture was administered by the same physician at hospital once a month (for three times in total). Patients were assessed before the injection and every month thereafter for pain frequency and severity, number of times analgesics were used and any appearant side effects during a 6 mo follow-up.


Eight of nine patients reported a marked decrease in frequency and severity of migraine attacks in comparison to their baseline symptoms; one reported no significant change (not more than 50%) from baseline and did not accept the second injection. GON block resulted in considerable reduction in pain frequency and severity and need to use analgesics up to three months after the injection in the present cases. The patients did not report any adverse effects.


Hereby we noticed a remarkable success with refractory chronic migraine patients. We believe that this intervention can result in rapid relief of pain with the effects lasting for perhaps several weeks or even months. Further controlled clinical trials are warranted to evaluate the effect of GON block in the treatment of refractory migraine cases.

Keywords: Migraine, Headache, Chronic migraine, Refractory migraine, Greater occipital nerve, Nerve block

Core tip: In this observational study, we report the results of 9 patients with refractory chronic migraine. The greater occipital nerve block with lidocaine seems to be one of the reliable treatment methods for the transitional treatment of refractory chronic migraine in order to take them back toward non-refractoriness which can be easily solved by the preventive therapies conventionally accepted. We think that this procedure can be effective in refractory migraine cases and should be included in our management plan.