Greater occipital nerve block as preventive treatment in migraine: a time‐to‐event analysis

Introduction: Greater occipital nerve block (GON-B) may still represent a valuable strategy in migraine prophylaxis despite the development of newer drugs. The absence of a standardized method leads to variable outcomes and limits its use. In this light, we investigated GON-B effects in a migraine population trying to define its duration and response predictors. Methods: In this real-world study, we recruited patients with migraine who underwent bilateral GON-B. They were clinically evaluated at baseline and then monthly for the next 3 months, using a 30-day headache diary. The potential role of baseline headache characteristics in predicting treatment response was thoroughly analyzed. Results: A total of 73 patients were enrolled: 50 (68%) were affected by chronic migraine while 38 (52%) by medication overuse headache (MOH). The greatest clinical benefit due to GON-B was reported during the first month, although the therapeutic response was substantially maintained during follow-up. Notably, similar outcomes were recorded in patients with and without MOH. The mean duration of effect was 55.3 ± 72.0 days, with no clinical variables significantly influencing this parameter. The therapeutic response seemed to be stronger in patients with migraine with aura. Conclusions: GON-B appears an effective option in migraine prophylaxis, even in difficult-to-treat patients. Its rapid effect, high tolerability, and cost-effectiveness represent indisputable advantages. A prolonged duration of action, which could be favored by the combination of anesthetic and steroid and needs to be confirmed in future studies, may further optimize patient management.