期刊
JOURNAL OF HEADACHE AND PAIN
卷 19, 期 -, 页码 -出版社
BMC
DOI: 10.1186/s10194-018-0835-5
关键词
Pediatric headache; Greater occipital nerve injection; Chronic migraine; Trigeminal autonomic cephalalgia; Cluster headache; New daily persistent headache
资金
- Allergan
- Amgen
- Eli-Lilly and Company
- Akita Biomedical
- Alder Biopharmaceuticals
- Avanir Pharma
- Cipla Ltd.
- Dr. Reddy's Laboratories
- eNeura
- Electrocore LLC
- Novartis
- Pfizer Inc.
- Quest Diagnostics
- Scion
- Teva Pharmaceuticals
- Trigemina Inc.
- MedicoLegal work
- Journal Watch
- Up-to-Date
- Massachusetts Medical Society
- Oxford University Press
- Bristol Myers Squibb (BMS)
- Merck Sharpe and Dohme (MSD)
- Janssen India
Background: Pediatric headache disorders can be extremely disabling, with marked reduction in the quality of life of children and their carers. Evidenced-based options for the treatment of primary headache disorders with preventive medication is limited and clinical outcomes are often unsatisfactory. Greater occipital nerve injections represent a rapid and well-tolerated therapeutic option, which is widely used in clinical practice in adults, and has previously shown a good outcome in a pediatric population. Methods:This service evaluation reviewed greater occipital nerve injections performed unilaterally with 30 mg 1% lidocaine and 40 mg methylprednisolone, to treat disabling headache disorders in children and adolescents. Results:We analyzed a total of 159 patients who received 380 injections. Of the population, 79% had chronic migraine, 14% new daily persistent headache, 4% a trigeminal autonomic cephalalgia, 3% secondary headache and one patient had chronic tension-type headache. An improvement after injection was seen in 66% (n = 105) of subjects, lasting on average 9 +/- 4 weeks. Improvement was seen in 68% of patients with chronic migraine, 67% with a trigeminal autonomic cephalalgia and 59% with new daily persistent headache. Side effects were reported in 8% and were mild and transient. Older age, female gender, chronic migraine, increased number of past preventive use, medication overuse and developing side effects were all associated with an increased likelihood of positive treatment outcome. Conclusions:This large single centre service evaluation confirms that unilateral injection of the greater occipital nerve is a safe, rapid-onset and effective treatment strategy in disabling headache disorders in children, with a range of diagnoses and severity of the condition, and with minimal side effects.
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