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Great occipital nerve long-acting steroid injections in cluster headache therapy: an observational prospective study
BACKGROUND: Injections targeting the occipital nerve are used to reduce headache attacks and abort cluster bouts in cluster headache patients. There is no widely accepted agreement over the optimal technique of injection, type and doses of steroids and/or anesthetics to use, as well as injection reg...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Berlin Heidelberg
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8940833/ https://www.ncbi.nlm.nih.gov/pubmed/34820736 http://dx.doi.org/10.1007/s00415-021-10884-0 |
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author | Merli, Elena Asioli, Gian Maria Favoni, Valentina Zenesini, Corrado Mascarella, Davide Sartori, Alex Cortelli, Pietro Cevoli, Sabina Pierangeli, Giulia |
author_facet | Merli, Elena Asioli, Gian Maria Favoni, Valentina Zenesini, Corrado Mascarella, Davide Sartori, Alex Cortelli, Pietro Cevoli, Sabina Pierangeli, Giulia |
author_sort | Merli, Elena |
collection | PubMed |
description | BACKGROUND: Injections targeting the occipital nerve are used to reduce headache attacks and abort cluster bouts in cluster headache patients. There is no widely accepted agreement over the optimal technique of injection, type and doses of steroids and/or anesthetics to use, as well as injection regimens. The aim of this study was to verify the effectiveness and safety of greater occipital nerve long-acting steroid injections in the management of episodic and chronic cluster headache. METHODS: We conducted a prospective observational cohort study on episodic (ECH) and chronic cluster headache patients (CCH). ECH were included in the study at the beginning of a cluster period. Three injections with 60 mg methylprednisolone were performed on alternate days. We registered the frequency and intensity of attacks three days before and 3, 7 and 30 days after the treatment, the latency of cluster relapse, adverse events, scores evaluating anxiety (Zung scale), depression (Beck’s Depression Scale) and quality of life (Disability Assessment Schedule II, 12-Item Self-Administered Version). Primary outcome was the interruption of the cluster after the three injections. Responders conducted a follow-up period of 12 months. RESULTS: We enrolled 60 patients, 47 with ECH and 13 with CCH. We observed a complete response in 47.8% (22/46) of episodic and 33.3% (4/12) of chronic patients. Moreover, a partial response (reduction of at least 50% of attacks) was obtained in further 10.8% (5/46) of episodic and in 33.3% (4/12) of chronic patients at 1 month. Median pain-free period was of 3 months for CCH responders. Only mild adverse events were reported in 38.3% (23/58) cases. CONCLUSIONS: We suggest three greater occipital nerve injections of 60 mg methylprednisolone on alternate days as useful therapy in episodic and chronic cluster headache. This leads to a long pain-free period in chronic forms. Adverse effects are mild and support its use as first choice. TRIAL REGISTRATION: The study was inserted in AIFA observational studies register. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00415-021-10884-0. |
format | Online Article Text |
id | pubmed-8940833 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
spelling | pubmed-89408332022-04-07 Great occipital nerve long-acting steroid injections in cluster headache therapy: an observational prospective study Merli, Elena Asioli, Gian Maria Favoni, Valentina Zenesini, Corrado Mascarella, Davide Sartori, Alex Cortelli, Pietro Cevoli, Sabina Pierangeli, Giulia J Neurol Short Commentary BACKGROUND: Injections targeting the occipital nerve are used to reduce headache attacks and abort cluster bouts in cluster headache patients. There is no widely accepted agreement over the optimal technique of injection, type and doses of steroids and/or anesthetics to use, as well as injection regimens. The aim of this study was to verify the effectiveness and safety of greater occipital nerve long-acting steroid injections in the management of episodic and chronic cluster headache. METHODS: We conducted a prospective observational cohort study on episodic (ECH) and chronic cluster headache patients (CCH). ECH were included in the study at the beginning of a cluster period. Three injections with 60 mg methylprednisolone were performed on alternate days. We registered the frequency and intensity of attacks three days before and 3, 7 and 30 days after the treatment, the latency of cluster relapse, adverse events, scores evaluating anxiety (Zung scale), depression (Beck’s Depression Scale) and quality of life (Disability Assessment Schedule II, 12-Item Self-Administered Version). Primary outcome was the interruption of the cluster after the three injections. Responders conducted a follow-up period of 12 months. RESULTS: We enrolled 60 patients, 47 with ECH and 13 with CCH. We observed a complete response in 47.8% (22/46) of episodic and 33.3% (4/12) of chronic patients. Moreover, a partial response (reduction of at least 50% of attacks) was obtained in further 10.8% (5/46) of episodic and in 33.3% (4/12) of chronic patients at 1 month. Median pain-free period was of 3 months for CCH responders. Only mild adverse events were reported in 38.3% (23/58) cases. CONCLUSIONS: We suggest three greater occipital nerve injections of 60 mg methylprednisolone on alternate days as useful therapy in episodic and chronic cluster headache. This leads to a long pain-free period in chronic forms. Adverse effects are mild and support its use as first choice. TRIAL REGISTRATION: The study was inserted in AIFA observational studies register. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00415-021-10884-0. Springer Berlin Heidelberg 2021-11-25 2022 /pmc/articles/PMC8940833/ /pubmed/34820736 http://dx.doi.org/10.1007/s00415-021-10884-0 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Short Commentary Merli, Elena Asioli, Gian Maria Favoni, Valentina Zenesini, Corrado Mascarella, Davide Sartori, Alex Cortelli, Pietro Cevoli, Sabina Pierangeli, Giulia Great occipital nerve long-acting steroid injections in cluster headache therapy: an observational prospective study |
title | Great occipital nerve long-acting steroid injections in cluster headache therapy: an observational prospective study |
title_full | Great occipital nerve long-acting steroid injections in cluster headache therapy: an observational prospective study |
title_fullStr | Great occipital nerve long-acting steroid injections in cluster headache therapy: an observational prospective study |
title_full_unstemmed | Great occipital nerve long-acting steroid injections in cluster headache therapy: an observational prospective study |
title_short | Great occipital nerve long-acting steroid injections in cluster headache therapy: an observational prospective study |
title_sort | great occipital nerve long-acting steroid injections in cluster headache therapy: an observational prospective study |
topic | Short Commentary |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8940833/ https://www.ncbi.nlm.nih.gov/pubmed/34820736 http://dx.doi.org/10.1007/s00415-021-10884-0 |
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