Greater occipital nerve blockade in cluster headache: effectiveness and safety of a combined injection protocol

Cluster headache (CH) is the most common disorder among trigeminal autonomic cephalalgia (TACs). It is characterized by attacks of harrowing unilateral pain associated with cranial autonomic symptoms and a restless and agitated behavior, occurring in bouts or clusters. Optimal management includes acute, prophylactic, and transitional treatments. Acute therapy is aimed to interrupt a single attack, while prophylaxes are intended to reduce intensity and frequency of pain as well as to shorten cluster duration. However, preventive dosage titration can cause a delayed pain relief, overuse of triptans, and poor quality of life. Greater occipital nerve blockade (GONB) has proved to be an effective and safe transitional treatment option. This interventional, open-label study aimed to evaluate the effectiveness and safety of the GONB protocol with methylprednisolone and lidocaine in CH Thirty days after the injection, ten patients (31%) were attack-free, reaching the primary outcome, while a total amount of 19 patients (59%) showed a reduction of at least 50% of daily attacks reaching the secondary outcome.