Clinical characteristics and overuse patterns of medication overuse headache: Retrospective case-series study.

According to Eurolight project's results, frequency of medication overuse headache in Lithuania is similar to other European countries. However, data on the characteristics of the disorder is lacking. OBJECTIVE: The aim was to analyze clinical characteristics and overuse patterns of patients with medication overuse headache. PATIENTS AND METHODS: Retrospective study was conducted in out-patient department of university hospital. 57.0% of the patients were from Vilnius and 43.0% from other cities and districts of Lithuania. Medical histories of patients consulted by headache specialist on private (86.2%) or public basis from 2008 to 2015 were analyzed. Diagnoses prior to 2013 were revised according to ICHD-III beta criteria. Overuse patterns were calculated only for patients with migraine. RESULTS: 87 patients (90.8% female) with mean age of 43.78 years were included in the study and 67 of them had primary diagnosis of migraine. Mean duration of overuse was 4.00 years. Mean headache frequency was 24.11days per month. Triptans more often were overused by younger patients (p=0.049). 41.8% of migraine patients with MOH overused triptans, 38.8% simple, and 38.8% combination-analgesics. 1 (1.5%) patient overused ergotamines, 7.5% were poly-overusers and no pure opioid overuse was found. Among patients with migraine most common overused medications were sumatriptan (38.8%), caffeine containing combination-analgesics (35.8%) and ibuprofen (20.9%). CONCLUSION: Triptans were most commonly overused drugs among patients with migraine. Fairly frequent overuse of combination-analgesics for migraine should raise concern.

Ultrasound-guided greater occipital nerve block: an efficient technique in chronic refractory migraine without aura?

BACKGROUND: The effectiveness of greater occipital nerve block (GONB) in patients with primary headache syndromes is controversial. Few studies have been evaluated the usefulness of GONB in patients with migraine without aura (MWOA). OBJECTIVE: To compare the effectiveness of ultrasound-guided GONB using bupivacaine 0.5% and placebo on clinical improvement in patients with refractory MWOA in a randomized, double-blinded clinical trial. STUDY DESIGN: A prospective, randomized, placebo-controlled, double-blind pilot trial. SETTING: Physical medicine and rehabilitation and neurology departments of a University Hospital. METHODS: Thirty-two patients with a diagnosis of MWOA according to the International Classification of Headache Disorders-II criteria were included in the study. Twenty-three patients (2 men, 21 women) completed the study. They were randomly assigned to receive either GONB with local anesthetic (bupivacaine 0.5% 1.5 mL) or greater occipital nerve (GON) injection with normal saline (0.9% 1.5 mL). Ultrasound-guided GONB was performed to more accurately locate the nerve. All procedures were performed using a 7 - 13 MHz high-resolution linear ultrasound transducer. The treatment group was comprised of 11 patients and the placebo group was comprised of 12 patients. The primary outcome measure was the change in the headache severity score during the one-month post-intervention period. Headache severity was assessed with a visual analogue scale (VAS) from 0 (no pain) to 10 (intense pain). RESULTS: In both groups, a decrease in headache intensity on the injection side was observed during the first post-injection week and continued until the second week. After the second week, the improvement continued in the treatment group, and the VAS score reached 0.97 at the end of the fourth week. In the placebo group after the second week, the VAS values increased again and nearly reached the pre-injection levels. The decrease in the monthly average pain intensity score on the injected side was statistically significant in the treatment group (P = 0.003), but not in the placebo group (P = 0.110). No statistically significant difference in the monthly average pain intensity score was observed on the uninjected side in either group (treatment group, P = 0.994; placebo group, P = 0.987). No serious side effect was observed after the treatment in either group. Only one patient had a self-limited vaso-vagal syncope during the procedure. LIMITATIONS: This trial included a relatively small sample. This may have been the result of the inclusion of only those patients who correctly completed their pain diaries. Another major limitation is the short follow-up duration. Patients were followed for one month after the injection, thus relatively long-term effects of the injection have not been observed. CONCLUSIONS: Ultrasound guided GONB with 1.5 mL of 0.5% bupivacaine for the treatment of migraine patients is a safe, simple, and effective technique without severe adverse effects. To increase the effectiveness of the injection, and to implement the isolated GONB, ultrasonography guidance could be suggested.