Skip to main content

Advertisement

SpringerLink
Log in

Clinical success of greater occipital nerve blockade in improving sleep quality of chronic migraineurs: a prospective observational study

  • Neurology • Original Article
  • Published:
Sleep and Breathing Aims and scope Submit manuscript

Abstract

Background

The success of various therapy methods in the treatment of insomnia and poor quality sleep, both of which play an active role in the chronicization process of migraine, has been the subject of investigation. The aim of this research was to evaluate the success, acceptability, and efficacy of greater occipital nerve block (GON-B) therapy in chronic migraine (CM) patients in improving their sleep quality and developing their beliefs about sleep .

Methods

The study included 40 patients with CM from the general population who agreed to receive blockade therapy. Before the injection treatment, 1-week sleep diaries as well as depression and anxiety symptoms were examined. The Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Pre-Sleep Arousal Scale (PSAS), Epworth Sleepiness Scale (ESS), and Dysfunctional Beliefs and Attitudes about Sleep (DBAS) scales were measured and evaluated both before and after the completion of 3 months of treatment.

Results

Thirty-seven patients with CM successfully completed our 12-week treatment period. The anxiety and depression scales of the patients decreased after 3 months (p < 0.001). PSQI and its subgroups ratings significantly improved after treatment (p < 0.001). Similarly, ISI, ESS, PSAS, and DBAS test scores also improved after treatment (p < 0.001).

Conclusions

This study provides evidence as to the applicability and acceptability of GON-B in CM treatment in terms of increased sleep quality; improved sleep beliefs, attitudes, and behaviors; and arousals and decreased insomnia findings.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

CM:

Chronic migraine

DBAS:

Dysfunctional Beliefs and Attitudes about Sleep

ESS:

Epworth Sleepiness Scale

GON-B:

Greater occipital nerve block

ISI:

Insomnia Severity Index

PSAS:

Pre-sleep arousal scale

PSQI:

Pittsburgh Sleep Quality Index

References

  1. Arnold M (2018) Headache classification committee of the international headache society (IHS) the international classification of headache disorders. Cephalalgia 38(1):1–211

    Article  Google Scholar 

  2. Natoli, J., et al., Global prevalence of chronic migraine: a systematic review. Cephalalgia, 2009: p. no-no.

  3. Borkum JM (2018) Harnessing migraines for neural regeneration. Neural Regen Res 13(4):609–615

    Article  Google Scholar 

  4. Buse DC, Greisman JD, Baigi K, Lipton RB (2019) Migraine progression: a systematic review. Headache 59(3):306–338

    Article  Google Scholar 

  5. Andreou AP, Edvinsson L (2019) Mechanisms of migraine as a chronic evolutive condition. J Headache Pain 20(1):117

    Article  Google Scholar 

  6. Schoonman, G.G., H.W. Schytz, and M. Ashina, Migraine trigger factors. Oxford Textbook of Headache Syndromes, 2020: p. 67.

  7. Boardman HF, Thomas E, Millson DS, Croft PR (2005) Psychological, sleep, lifestyle, and comorbid associations with headache. Headache 45(6):657–669

    Article  Google Scholar 

  8. Irish LA, Kline CE, Gunn HE, Buysse DJ, Hall MH (2015) The role of sleep hygiene in promoting public health: a review of empirical evidence. Sleep Med Rev 22:23–36

    Article  Google Scholar 

  9. Karacan I, Thornby JI, Anch AM, Booth GH, Williams RL, Salis PJ (1976) Dose-related sleep disturbances induced by coffee and caffeine. Clin Pharmacol Ther 20(6):682–689

    Article  CAS  Google Scholar 

  10. Ong JJY, De Felice M (2018) Migraine treatment: current acute medications and their potential mechanisms of action. Neurotherapeutics 15(2):274–290

    Article  CAS  Google Scholar 

  11. Vagharseyyedin SA, Salmabadi M, BahramiTaghanaki H, Riyasi H (2019) The impact of self-administered acupressure on sleep quality and fatigue among patients with migraine: a randomized controlled trial. Complement Ther Clin Pract 35:374–380

    Article  Google Scholar 

  12. Blumenfeld A, Ashkenazi A, Grosberg B, Napchan U, Narouze S, Nett B, DePalma T, Rosenthal B, Tepper S, Lipton RB (2010) Patterns of use of peripheral nerve blocks and trigger point injections among headache practitioners in the USA: results of the American Headache Society Interventional Procedure Survey (AHS-IPS). Headache 50(6):937–942

    Article  Google Scholar 

  13. Ashkenazi A, Blumenfeld A, Napchan U, Narouze S, Grosberg B, Nett R, DePalma T, Rosenthal B, Tepper S, Lipton RB (2010) Peripheral nerve blocks and trigger point injections in headache management–a systematic review and suggestions for future research. Headache 50(6):943–952

    Article  Google Scholar 

  14. Ashkenazi A, Young WB (2005) The effects of greater occipital nerve block and trigger point injection on brush allodynia and pain in migraine. Headache 45(4):350–354

    Article  Google Scholar 

  15. Blumenfeld A, Ashkenazi A, Napchan U, Bender SD, Klein BC, Berliner R, Ailani J, Schim J, Friedman DI, Charleston L IV, Young WB, Robertson CE, Dodick DW, Silberstein SD, Robbins MS (2013) Expert consensus recommendations for the performance of peripheral nerve blocks for headaches–a narrative review. Headache 53(3):437–446

    Article  Google Scholar 

  16. Inan N, Inan LE, Coskun O, Tunc T, Ilhan M (2016) Effectiveness of greater occipital nerve blocks in migraine prophylaxis. Noro Psikiyatr Ars 53(1):45–48

    Article  Google Scholar 

  17. Ünal-Artık HA, İnan LE, Ataç-Uçar C, Yoldaş TK (2017) Do bilateral and unilateral greater occipital nerve block effectiveness differ in chronic migraine patients? Neurol Sci 38(6):949–954

    Article  Google Scholar 

  18. Buysse DJ, Reynolds CF III, Monk TH, Berman SR, Kupfer DJ (1989) The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 28(2):193–213

    Article  CAS  Google Scholar 

  19. Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14(6):540–545

    Article  CAS  Google Scholar 

  20. Morin CM, Stone J, Trinkle D, Mercer J, Remsberg S (1993) Dysfunctional beliefs and attitudes about sleep among older adults with and without insomnia complaints. Psychol Aging 8(3):463–467

    Article  CAS  Google Scholar 

  21. Edinger JD, Wohlgemuth WK, Radtke RA, Marsh GR, Quillian RE (2001) Does cognitive-behavioral insomnia therapy alter dysfunctional beliefs about sleep? Sleep 24(5):591–599

    Article  CAS  Google Scholar 

  22. Bastien CH, Vallieres A, Morin CM (2001) Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med 2(4):297–307

    Article  Google Scholar 

  23. Nicassio PM, Mendlowitz DR, Fussell JJ, Petras L (1985) The phenomenology of the pre-sleep state: the development of the pre-sleep arousal scale. Behav Res Ther 23(3):263–271

    Article  CAS  Google Scholar 

  24. Beck AT, Steer RA, Carbin MG (1988) Psychometric properties of the Beck Depression Inventory: twenty-five years of evaluation. Clin Psychol Rev 8(1):77–100

    Article  Google Scholar 

  25. Beck AT, Epstein N, Brown G, Steer RA (1988) An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol 56(6):893–897

    Article  CAS  Google Scholar 

  26. Inan LE, Inan N, Unal-Artık HA, Atac C, Babaoglu G (2019) Greater occipital nerve block in migraine prophylaxis: narrative review. Cephalalgia 39(7):908–920

    Article  Google Scholar 

  27. Inan L et al (2015) Greater occipital nerve blockade for the treatment of chronic migraine: a randomized, multicenter, double-blind, and placebo-controlled study. Acta Neurol Scand 132(4):270–277

    Article  CAS  Google Scholar 

  28. Young WB (2010) Blocking the greater occipital nerve: utility in headache management. Curr Pain Headache Rep 14(5):404–408

    Article  Google Scholar 

  29. Bigal ME, Lipton RB (2008) Clinical course in migraine: conceptualizing migraine transformation. Neurology 71(11):848–855

    Article  Google Scholar 

  30. Cooke L, Eliasziw M, Becker WJ (2007) Cutaneous allodynia in transformed migraine patients. Headache 47(4):531–539

    PubMed  Google Scholar 

  31. Mathew NT, Reuveni U, Perez F (1987) Transformed or evolutive migraine. Headache 27(2):102–106

    Article  CAS  Google Scholar 

  32. Andreou AP, Edvinsson L (2019) Mechanisms of migraine as a chronic evolutive condition. J Headache Pain 20(1):1–17

  33. Alstadhaug K (2009) Migraine and the hypothalamus. Cephalalgia 29(8):809–817

    Article  CAS  Google Scholar 

  34. Shauly O, Gould DJ, Sahai-Srivastava S, Patel KM (2019) Greater occipital nerve block for the treatment of chronic migraine headaches: a systematic review and meta-analysis. Plast Reconstr Surg 144(4):943–952

    Article  CAS  Google Scholar 

  35. Cooper, W.M. and A.K. Masih, Cervicogenic headache, in Headache and Migraine Biology and Management. 2015, Elsevier. p. 203-212.

  36. Yilmaz V, Aras B, Erturk FA, Cakcı FA, Umay E (2019) Migraine in patients with fibromyalgia and outcomes of greater occipital nerve blockage. Clin Neurol Neurosurg 181:54–57

    Article  Google Scholar 

  37. Flamer D, Alakkad H, Soneji N, Tumber P, Peng P, Kara J, Hoydonckx Y, Bhatia A (2019) Comparison of two ultrasound-guided techniques for greater occipital nerve injections in chronic migraine: a double-blind, randomized, controlled trial. Reg Anesth Pain Med 44(5):595–603

    Article  Google Scholar 

  38. Ulusoy EK, Bolatturk OF (2020) The effect of greater occipital nerve blockade on the quality of life, disability and comorbid depression, anxiety, and sleep disturbance in patients with chronic migraine. Neurol Sci 41:1829–1835

    Article  Google Scholar 

  39. Morin CM, Vallières A, Ivers H (2007) Dysfunctional beliefs and attitudes about sleep (DBAS): validation of a brief version (DBAS-16). Sleep 30(11):1547–1554

    Article  Google Scholar 

  40. Kloss JD, Nash CO, Walsh CM, Culnan E, Horsey S, Sexton-Radek K (2016) A “Sleep 101” program for college students improves sleep hygiene knowledge and reduces maladaptive beliefs about sleep. Behav Med 42(1):48–56

    Article  Google Scholar 

  41. Crawford MR, Luik AI, Espie CA, Taylor HL, Burgess HJ, Jones AL, Rush University Sleep Research Team, Ong JC (2020) Digital cognitive behavioral therapy for insomnia in women with chronic migraines. Headache 60:902–915

    Article  Google Scholar 

  42. Cox RC, Olatunji BO (2016) A systematic review of sleep disturbance in anxiety and related disorders. J Anxiety Disord 37:104–129

    Article  Google Scholar 

  43. Song Z et al (2009) Pain relief by spinal cord stimulation involves serotonergic mechanisms: an experimental study in a rat model of mononeuropathy. Pain 147(1-3):241–248

    Article  CAS  Google Scholar 

  44. Vgontzas A, Pavlovic JM (2018) Sleep disorders and migraine: review of literature and potential pathophysiology mechanisms. Headache 58(7):1030–1039

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurology, School of Medicine, Yozgat Bozok University, Erdogan Akdag Campus, Ataturk Road 7. Km, 66100, Yozgat, Turkey

    Hikmet Saçmacı, Tülin Aktürk & Nermin Tanık

  2. Neurology Clinic, Ministry of Health Ankara Research and Training Hospital, 06230, Ankara, Turkey

    Levent Ertuğrul İnan

Authors
  1. Hikmet Saçmacı
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tülin Aktürk
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nermin Tanık
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Levent Ertuğrul İnan
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Hikmet Saçmacı: Concept, blockade therapy, wrote the initial manuscript, acquisition of data, and review of manuscript. Tülin Aktürk: blockade therapy, patient monitoring, and review of manuscript. Nermin Tanık: blockade therapy and review of manuscript. Levent Ertuğrul İnan: Concept, initiation, and critical revision of manuscript.

Corresponding author

Correspondence to Hikmet Saçmacı.

Ethics declarations

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study protocol was approved by the Local Ethics Committee

Informed consent

Informed consent was obtained from all individual participants included in the study

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Saçmacı, H., Aktürk, T., Tanık, N. et al. Clinical success of greater occipital nerve blockade in improving sleep quality of chronic migraineurs: a prospective observational study. Sleep Breath 25, 1003–1010 (2021). https://doi.org/10.1007/s11325-021-02309-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-021-02309-z

Keywords

Search

Navigation