Neurophysiological correlates of clinical improvement after greater occipital nerve (GON) block in chronic migraine: relevance for chronic migraine pathophysiology

Autor: Alessandro Viganò, Maria Claudia Torrieri, Massimiliano Toscano, Francesca Puledda, Barbara Petolicchio, Tullia Sasso D’Elia, Angela Verzina, Sonia Ruggiero, Marta Altieri, Edoardo Vicenzini, Jean Schoenen, Vittorio Di Piero
Jazyk: angličtina
Rok vydání: 2018
Předmět:
Zdroj: The Journal of Headache and Pain, Vol 19, Iss 1, Pp 1-9 (2018)
Druh dokumentu: article
ISSN: 1129-2369
1129-2377
DOI: 10.1186/s10194-018-0901-z
Popis: Abstract Background Therapeutic management of Chronic Migraine (CM), often associated with Medication Overuse Headache (MOH), is chiefly empirical, as no biomarker predicting or correlating with clinical efficacy is available to address therapeutic choices. The present study searched for neurophysiological correlates of Greater Occipital Nerve Block (GON-B) effects in CM. Methods We recruited 17 CM women, of whom 12 with MOH, and 19 healthy volunteers (HV). Patients had no preventive treatment since at least 3 months. After a 30-day baseline, they received a bilateral betamethasone-lidocaine GON-B of which the therapeutic effect was assessed 1 month later. Habituation of visual evoked potentials (VEP) and intensity dependence of auditory evoked potentials (IDAP) were recorded before and 1 week after the GON-B. Results At baseline, CM patients had a VEP habituation not different from HV, but a steeper IDAP value than HV (p = 0.01), suggestive of a lower serotonergic tone. GON-B significantly reduced the number of total headache days per month (− 34.9%; p = 0.003). Eight out 17CM patients reversed to episodic migraine and medication overuse resolved in 11 out of 12 patients. One week after the GON-B VEP habituation became lacking respect to baseline (p = 0.01) and to that of HV (p = 0.02) like in episodic migraine, while the IDAP slope significantly flattened (p
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