Utility of greater occipital nerve anesthetic blockade in the treatment of status migrainosus in the pediatric emergency department

Abstract

Introduction: Headaches are becoming increasingly common in children and adolescents, leading to a rise in emergency department visits and hospitalizations. This study explores alternative therapeutic options, focusing on the anesthetic blockade of the greater occipital nerve (GON) for paediatric migraines.

Materials and methods: A prospective study assessing the utility of the anesthetic blockade in the GON zone with 0.5 % Bupivacaine in adolescents with refractory migraines. Inclusion criteria involve adolescents aged 12 to 17 with a diagnosis of migraine status. The study outlines the infiltration technique, efficacy assessment, and sustained utility evaluation, aiming to determine the safety, effectiveness, and patient satisfaction associated with the procedure.

Results: Out of 24 patients with migraine status, 92 % were females, with an average age of 14 years. Two-thirds reported incapacitating pain, and associated symptoms included nausea, vomiting, dizziness, syncope, phonophobia, and photophobia. The anesthetic blockade resulted in statistically significant total or partial improvement in the majority of patients, with sustained effectiveness observed at the 7-day follow-up. High satisfaction with the treatment was reported, and no adverse effects were documented.

Conclusion: The anesthetic blockade in the GON zone emerges as a safe and effective strategy for the treatment of paediatric migraines in the emergency department. High patient satisfaction and sustained effectiveness support its consideration, emphasizing the need for consensus and clinical trials to standardize procedures and indications across diverse populations.

Keywords: Anesthetic; Blockade; Greater; Headache; Nerve; Occipital.