Skip to main content

Advertisement

Log in

The role of nerve blocks and botulinum toxin injections in the management of cluster headaches

  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

Cluster headache (CH) is a primary headache syndrome that is classified with the trigeminal autonomic cephalalgias. CH treatment involves three steps: acute attack management, transitional therapy, and preventive therapy. Greater occipital nerve block has been shown to be an effective alternative bridge therapy to oral steroids in CH. Botulinum toxin type A has recently been studied as a new preventive treatment for patients with chronic CH, with limited success.

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

Access this article

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

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. Rozen T: Trigeminal autonomic cephalalgias. Continuum Headache 2006, 6:171–193.

    Google Scholar 

  2. Headache Classification Committee of the International Headache Society: The International Classification of Headache Disorders 2nd ed. Cephalalgia 2004 24(Suppl 1):1–160.

    Google Scholar 

  3. May A: Cluster headache: pathogenesis, diagnosis, and management. Lancet 2005, 366:843–855.

    Article  PubMed  Google Scholar 

  4. Dodick DW, Rozen TD, Goadsby PJ, et al.: Cluster headache. Cephalalgia 2000, 20:787–803.

    Article  PubMed  CAS  Google Scholar 

  5. Leone M, D’Amico D, Attanasio A, et al.: Verapamil is an effective prophylactic for cluster headache: results of a double blind multicenter study versus placebo. In: Cluster Headache and Related Conditions. Edited by Olesen J, Goadsby PJ. Oxford: Oxford University Press; 1999:296–299.

    Google Scholar 

  6. Bussone G, Leone M, Peccarisi C, et al.: Double blind comparison of lithium and verapamil in cluster headache prophylaxis. Headache 1990, 30:411–417.

    Article  PubMed  CAS  Google Scholar 

  7. Lainez MJ, Pascual J, Pascual AM, et al.: Topiramate in the prophylactic treatment of cluster headache. Headache 2003, 43:784–789.

    Article  PubMed  Google Scholar 

  8. Pascual J, Lainez M, Dodick D, et al.: Antiepileptic drugs for the treatment of chronic and episodic cluster headache: a review. Headache 2007, 47:81–89.

    PubMed  Google Scholar 

  9. Leone M, D’Amico D, Moschiano F, et al.: Melatonin versus placebo in the prophylaxis of cluster headache: a double-blind pilot study with parallel groups. Cephalalgia 1996, 16:494–496.

    Article  PubMed  CAS  Google Scholar 

  10. Peres MF, Rozen TD: Melatonin in the preventive treatment of chronic cluster headache. Cephalalgia 2001, 10:993–995.

    Article  Google Scholar 

  11. Burns B, Watkins L, Goadsby P: Treatment of medically intractable cluster headache by occipital nerve stimulation: long-term follow-up of eight patients. Lancet 2007, 369:1099–1106.

    Article  PubMed  Google Scholar 

  12. Blersch W, Wilhelm SM, Saskia P, et al.: Botulinum toxin A and the cutaneous nociception in humans: a prospective, double-blind, placebo-controlled, randomized study. J Neurol Sci 2002, 205:59–63.

    Article  PubMed  CAS  Google Scholar 

  13. Allergan, Inc.: Allergan announces positive top-line results from phase III BOTOX(R) headache program. Available at http://agn360.client.shareholder.com/releasedetail.cfm?ReleaseID=333850. Accessed September 2008.

  14. Aoki KR: Evidence for antinociceptive activity of botulinum toxin Type A in pain management. Headache 2003, 43(Suppl 1):S9–S15.

    Article  PubMed  Google Scholar 

  15. Durham PL, Cady R: Regulation of calcitonin gene-related peptide secretion from trigeminal nerve cells by botulinum toxin type A: implications for migraine therapy. Headache 2004, 44:35–42.

    Article  PubMed  Google Scholar 

  16. Sostak P, Krause P, Forderreuther S, et al.: Botulinum toxin type-A therapy in cluster headache: an open study. J Headache Pain 2007, 8:236–241.

    Article  PubMed  CAS  Google Scholar 

  17. Robbins L: Botulinum toxin A for cluster headaches: 6 cases. Cephalalgia 2001, 21:499–500.

    Google Scholar 

  18. Freund BJ, Schwartz M: The use of Botulinum toxin-A in the treatment of refractory cluster headache: case reports. Cephalalgia 2000, 4:325–331.

    Google Scholar 

  19. Ekbom K, Solomon S: Management of cluster headaches. In: The Headaches, edn 2. Edited by Olesen J, Tfelt-Hansen P, Welch KMA. Philadelphia: Lippincott Williams & Wilkins; 2000:731–740.

    Google Scholar 

  20. Ashkenazi A, Levin M: Greater occipital nerve block for migraine and other headaches: is it useful? Curr Pain Headache Rep 2007, 11:231–235.

    Article  PubMed  Google Scholar 

  21. Ashkenazi A, Silberstein SD, Matro RA, et al.: Greater occipital nerve block for chronic daily headache using local anesthetic with or without corticosteroids: a randomized single-blind study [abstract]. Neurology 2006, 66:A223.

    Google Scholar 

  22. Ambrosini A, Vandenheede M, Rossi P, et al.: Suboccipital injection with a mixture of rapid and long-acting steroids in cluster headache: a double-blind placebo-controlled study. Pain 2005, 118:92–96.

    Article  PubMed  CAS  Google Scholar 

  23. Young WB, Marmura M, Ashkenazi A, et al.: Expert opinion: greater occipital nerve block and other anesthetic injections for primary headache disorders. Headache 2008, 48:1122–1125.

    Article  PubMed  Google Scholar 

  24. Anthony M: Arrest of attacks of cluster headache by local steroid injection of the occipital nerve. In: Migraine: Proceedings of the 5th International Migraine Symposium London 1984. Edited by Rose C. Basel: Karger; 1985:169–173.

    Google Scholar 

  25. Bigo A, Delrieu F, Bousser MG: Treatment of vascular pain of the face by methylprednisolone injection into the area of the greater occipital nerve: 16 cases. Rev Neurology 1989, 145:160–162.

    CAS  Google Scholar 

  26. Peres MFP, Stiles MA, Siow HC, et al.: Greater occipital nerve blockade for cluster headache. Cephalalgia 2002, 22:520–522.

    Article  PubMed  CAS  Google Scholar 

  27. Goadsby PJ, Zagami AS: Stimulation of the superior sagittal sinus increases metabolic activity and blood flow in certain regions of the brainstem and upper cervical spinal cord of the cat. Brain 1991, 114:1001–1011.

    Article  PubMed  Google Scholar 

  28. Bush V, Jakob W, Juergens T, et al.: Occipital nerve blockade in chronic cluster headache patients and functional connectivity between trigeminal and occipital nerves. Cephalalgia 2007, 1206–1214.

  29. Bush V, Jacob W, Juergens T, et al.: Functional connectivity between trigeminal and occipital nerves revealed by occipital nerve blockade and nociceptive blink reflexes. Cephalagia 2006, 26:50–55.

    Article  Google Scholar 

  30. Young W, Cook B, Shahram M, et al.: The first 5 minutes after greater occipital nerve block. Headache 2008, 48:1126–1139.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jessica Ailani.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ailani, J., Young, W.B. The role of nerve blocks and botulinum toxin injections in the management of cluster headaches. Current Science Inc 13, 164–167 (2009). https://doi.org/10.1007/s11916-009-0028-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11916-009-0028-7

Keywords

Navigation