Health Problem: Migraine is a chronic, familial neurological disorder characterized by episodic headache attacks that are typically unilateral and often debilitating, lasting for hours or days and occurring multiple times per month. It is the third most prevalent illness in the world and considered the most disabling of the neurological disorders. It affects approximately 18% to 20% of women and 6% to 10% of men in the United States, most commonly in those aged 25 to 55 years.

Technology Description: This report focuses on the efficacy and safety of greater occipital nerve block (GONB) for the preventive treatment of chronic migraine headaches in patients with an inadequate response to standard care. GONB involves injections of local anesthetic, with or without corticosteroid, into sites along the occipital nerve. For patients requiring repeated treatments, injections of local anesthetics should be performed at 2- to 4-week intervals, while corticosteroid injection should not be performed more frequently than every 3 months.

Controversy: The efficacy and durability of GONB and the criteria for patient selection have not been established for the treatment of migraine.

Key Questions:

  • Is GONB with local anesthetic effective in treating migraine relative to placebo?

  • Does corticosteroid added to local anesthetic improve effectiveness?

  • Is GONB for the treatment of migraine safe?

  • Have definitive patient selection criteria been identified for this technology?

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