Headache and Pain Research

Bilateral Greater Occipital Nerve Block for Preventing the OnabotulinumtoxinA Wear-off Phenomenon in the Treatment of Chronic Migraine: A Case Series of 12 Patients: Sanghyun Kim, Jae Young An, Dae Woong Bae; Headache Pain Res. 2024;25(2):111-116. Published online October 23, 2024; DOI: https://doi.org/10.62087/hpr.2024.0021

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Purpose: OnabotulinumtoxinA is widely used to treat chronic migraines; however, the wear-off phenomenon before the next scheduled dose has emerged as a challenge. This study suggests a new strategy for preventing the wear-off phenomenon using bilateral greater occipital nerve block.
Methods
We conducted a retrospective review of patients diagnosed with chronic migraine who were treated with onabotulinumtoxinA and bilateral greater occipital nerve block at St. Vincent Hospital from January 2023 to December 2023. Twelve chronic migraine patients with a history of the wear-off phenomenon received a greater occipital nerve block 8 weeks after the initial onabotulinumtoxinA injection for two sessions. Responses to treatment were evaluated with regular follow-ups and daily headache diaries.
Results
All patients who had previously experienced the wear-off phenomenon with conventional onabotulinumtoxinA treatment did not experience the wear-off phenomenon during two sessions with an additional greater occipital nerve block administered 8 weeks after each onabolulinumtoxinA injection.
Conclusion
Bilateral greater occipital nerve block administered 8 weeks after the initial onabotulinumtoxinA injection effectively prevents the wear-off phenomenon, enabling sustained therapeutic benefits in chronic migraine patients. Further research is needed to confirm these findings in larger cohorts.

Citations

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When Should Headache Specialists Hold a Needle? The Role of Botulinum Toxin Injections and Occipital Nerve Blocks
Soo-Jin Cho
Headache and Pain Research.2024; 25(2): 73. CrossRef

Paradoxical Postural Headache in Spontaneous Intracranial Hypotension with Infratentorial Superficial Siderosis: Dae Woong Bae, Min Seung Kim, Soo-Jin Cho; Korean J Headache. 2023;24(1):20-23. Published online June 30, 2023

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Abstract PDF: Spontaneous intracranial hypotension is characterized by orthostatic headache caused by cerebrospinal fluid (CSF) leakage. However, clinical presentation of SIH is variable, and normal or high intracranial pressure in CSF study is not uncommon. Infratentorial superficial siderosis (ISS) shares similar pathomechanism with SIH, as developed after chronic CSF leakage, whilst several years of latency after SIH onset. Here, we report a 47-year-old male patient who had experienced prominent orthostatic headache twenty years before, and presented reverse-orthostatic headache in this time, accompanying with radiological features of SIH and ISS in brain magnetic resonance imaging (MRI). CSF leakage was confirmed by spinal MRI and MR myelography, and his headache was aggravated after epidural blood patch.

Clinical Practice Guideline of Pharmacologic Treatment for Migraine Prevention in Adults 2021: The Committee of Clinical Practice Guideline of the Korean Headache Society: Kim Byung-Su, Jae Myun Chung, Pil-Wook Chung, Kwang-Yeol Park, Jin-Young Ahn, Heui-Soo Moon, Hong-Kyun Park, Dae Woong Bae, Jong-Geun Seo, Jong-Hee Sohn, Tae-Jin Song; Published online December 31, 2021

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Abstract PDF: 성인 편두통 예방치료 약제 진료지침 2021: 대한두통학회 진료지침위원회

Diagnosis of Cervicogenic Headache: Dae Woong Bae, Ko-Eun Choi, Seonghoon Kim, Jeong Wook Park; Published online June 30, 2021

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Abstract PDF: 경부인성 두통의 진단

Diagnostic Delay of Cluster Headache in Korea: Byung-Su Kim, Soo-Kyoung Kim, Pil-Wook Chung, Byung-Kun Kim, Mi Ji Lee, Min Kyung Chu, Jin-Young Ahn, Dae Woong Bae, Tae-Jin Song; Published online June 30, 2020

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Abstract PDF: 국내 군발두통의 진단지연

The Effect of Cognitive Impairment on the Frequency of Headaches in the Elderly: Dae Woong Bae, Si Ryoung Han, Jae Young An; Published online December 31, 2018

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Abstract PDF: 두개내 저혈압과 동반한 일측성 청력저하 및 MRI 소견

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