Repetitive Multiple Cranial Nerve Blocks Offer Effective Prevention for Chronic Migraine

Repetitive multiple cranial nerve blocks (MCNBs) may offer a clinically meaningful benefit as a preventative measure in patients with chronic migraine by reducing both the number of headache days as well as headache’s impact on social functioning and quality of life, according to a study in Headache.

In the single-center study, investigators from the Leeds Teaching Hospitals Trust in the United Kingdom recruited 64 patients with chronic migraine with or without aura who had not previously been treated with nerve blocks for headache. Participants were given MCNBs as preventative therapy between 2017 and 2019 and were followed up for up to 20 months.

Repetitive bilateral occipital nerve blocks (n=37) or bilateral occipital and trigeminal nerve blocks (n=27) were administered based on treatment response. The primary outcomes of the study were the proportion of participants with a ≥30% reduction in headache days at 4 weeks after block and the mean reduction in headache days at 4 weeks after the blocks. Patients’ headache diaries were used to collect outcome measurements. Additionally, scores on the Headache Impact Test 6 (HIT6) and patient-reported block effectiveness measures were also collected.

After MCNBs, the mean reduction in headache days across the entire cohort was 5.4 days (P <.001). Additionally, the mean reduction in HIT6 scores was 5.3 (P =.07). Approximately 66% (n=42) of patients who responded to the MCNBs met the primary outcome of a ≥30% reduction in headache days. The mean effect duration was 5.7 weeks. On follow-up, chronic migraine in 13 patients in the overall study transformed to low-frequency episodic migraine. Around one-third (34%; n=22) of patients had no reduction in either headache days or HIT6 scores following treatment. A total of 9 minor post-block complications were reported in 9 (8%) instances.

Limitations of the study included the use of self-reported measures of efficacy, the lack of a control group, and the single-center design.

Despite these limitations, the investigators concluded “that repetitive MCNBs with corticosteroids are safe and could be an effective alternate strategy in providing short-term headache prevention in patients with chronic migraine.”

Reference

Fernandes L, Khan N, Dobson J, Randall M, Idrovo L. Multiple cranial nerve blocks as an alternative preventative therapy for chronic migraine [published online March 30, 2020]. Headache. doi: 10.1111/head.13792