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Korean J Anesthesiol > Epub ahead of print
DOI: https://doi.org/10.4097/kja.19145    [Epub ahead of print]
Published online June 4, 2019.
Ultrasound-guided greater occipital nerve block with botulinum toxin for patients with chronic headache in the occipital area: a randomized controlled trial
Jae Hyung Ryu, Jae Hang Shim  , Jong Hoon Yeom  , Woo Jong Shin  , Sang Yun Cho  , Woo Jae Jeon 
Department of Anesthesiology and Pain Medicine College of Medicine, Hanyang University 153, Gyeongchun-ro, Guri 11923, KOREA, REPUBLIC OF
Corresponding author:  Jae Hang Shim, Tel: 81-31-560-2400, Fax: 81-31-563-1731, 
Received: 8 April 2019   • Revised: 2 June 2019   • Accepted: 3 June 2019
The ultrasound guided greater occipital nerve (GON) block has been frequently used for various types of headache and botulinum toxin has recently begun to be used in patients with headache. Our study presents the long term effect of botulinum toxin on the GON block using ultrasound in patients with chronic headache in occipital area.
Patients with occipital headache were divided into two groups (bupivacaine: group BUP (n=27), botulinum toxin: group BTX (n=27)) and ultrasound-guided GON block was performed on C2 level. The GON was detected using ultrasound technique and distance from the GON to midline, from the skin surface to the GON and size of GON was measured in both groups. The VAS scores and Likert scale were assessed at pretreatment, 1 week, 4 weeks, 8 weeks and 24 weeks after treatment on both groups.
The GON had a distance of 18.9 ± 4.4 mm (right) and 17.3 ± 3.8 mm (left) from the GON to midline. The depth from the skin was 12.9 ± 1.5 mm (right) and 13.4 ± 1.6 mm (left). The size of GON was measured as 3.1 mm on both sides. VAS score and patient satisfaction score (Likert scale) of 4 weeks, 8 weeks, 24 weeks after injection were superior in botulinum toxin group.
Ultrasound-guided GON block using botulinum toxin is effective in reducing short-term and long-term pain in patients with chronic headache in occipital area.
Key Words: Botox; Greater occipital nerve block; Headache; Likert scale; Long term follow up; Ultrasound; Visual analogue scale


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