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

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

Abstract-Summary The success of various therapy methods in the treatment of insomnia and poor qual- ity 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 .

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.

Thirty-seven patients with CM successfully completed our 12-week treat-

ment period.

ISI, ESS, PSAS, and DBAS test scores also improved after treatment (p < 0.001). 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, atti- tudes, and behaviors; and arousals and decreased insomnia findings.

Extended: The aim of our study was to observe the effects of GON-B treatment on poor sleep quality, sleep disorders, insomnia/excessive daytime sleepiness symp- toms, and sleep beliefs and behaviors and identify to what extent GON-B treatment affects pre-sleep arousality in chronic migraineurs.

Introduction Low sleep quality causes different levels of fatigue among migraine patients, and it is one of the symptoms that patients complain about the most [331].

Greater occipital nerve blocks (GON-B) have been a treatment method for

migraine in headache clinics over the last decade [332, 333].

Inan et al. were the first researchers to investigate the effectiveness of GON-B in

the treatment of migraine patients taking or not taking prophylactic medications.

We conducted a prospective cohort study to determine the effects of GON-B treatment on sleep quality, the components of sleep, arousality level, and sleep- related beliefs, behaviors, and attitudes in patients with chronic migraine to whom nerve blocks were applied for the first time to treat headaches.

We hypothesized that recurrent GON blockades would provide a clinically sig-

nificant benefit in relation to sleep disorders in chronic migraine patients.

Methods Exclusion criteria were previous treatment of nerve blockade, a history of any psy- chiatric disorder (self-reported or evaluated by clinical interview), substance abuse,

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4 Treatment

psychotic disorder, cognitive impairment, mental retardation, individuals who were illiterate, those with cardiac disorders, diabetes patients, pregnant-lactating women, those with a brain scan showing any form of mass, patients with uncontrolled hyper- tension, and patients who could not successfully complete the 12-week treatment period required for the research.

This is a 7-item self-rating scale used to evaluate the perceived severity of insom-

nia and related dysfunction in the previous week [334].

To evaluate the severity of depression, a Likert-type self-report scale was devel- oped by Beck et  al. The total score is from 0 to 63; higher scores indicate more severe depression [335].

Spearman’s correlation coefficient was used to evaluate the correlation between migraine characteristics and the scale scores indicated before and after 3 months of GON-B treatment.

Results We started the study with 40 patients, but three patients were excluded from the study due to relocation, arrhythmia, and failure to appear at the appointment time, so our study was completed with 37 patients age 23–56 years including 31 women (84%), who successfully completed the treatment process.

The results of this study primarily showed that the patients’ headache frequency, headache duration, and pain severity significantly decreased after the treatment (p < 0.05).

The chronic migraine patients, who had a mean number of 20.2 ± 5.5 headache days on average per month before the treatment, had 4.8 ± 5.5 headache days per month after completion of the treatment.

When we looked at the analysis of sleep quality after completion of the 3-month treatment of patients, the PSQI total score decreased from 7.6 ± 3.6 to 3.4 ± 2.2, indicating an improvement of 45%.

Discussion The aim of our study was to observe the effects of GON-B treatment on poor sleep quality, sleep disorders, insomnia/excessive daytime sleepiness symptoms, and sleep beliefs and behaviors and identify to what extent GON-B treatment affects pre-sleep arousality in chronic migraineurs.

The results obtained from this study provide evidence that sleep quality and sleep content improve, insomnia decreases, and attitudes and behaviors related to sleep can be objectively improved in patients who successfully complete the treat- ment process.

Although the role and importance of GON-B treatment in migraine has been shown in many recent studies, the number of studies on sleep quality and factors affecting sleep is limited.

In our study group, the sleep parameters were controlled for by multiple scales; after the treatment of pain and dysfunctional beliefs about pain, levels of comorbid anxiety and symptoms of depression also improved, with patients attaining enhanced and effective levels of sleep quality.

4.4 Emergency Department Management

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Conclusions Migraine treatment management is versatile, and planning an appropriate treatment, due to an extended anamnesis, is crucial not only to protect patients from an exces- sive and inappropriate drug burden but also to protect the country from the accom- panying financial burden.

GON-B treatment is actually very practical and easily applicable. To providing patients with pain treatment, it will contribute to both the improve- ment of sleep quality and sleep parameters as well as the control of dysfunctional attitudes to sleep and overexcitation through an improvement in anxiety and depres- sion symptoms.

Acknowledgement A machine generated summary based on the work of Saçmacı, Hikmet; Aktürk, Tülin; Tanık, Nermin; İnan, Levent Ertuğrul. 2021 in Sleep and Breathing.

4.4

Emergency Department Management

Machine generated keywords: emergency, diagnosis, discharge, emergency depart- ment, department, secondary headache, secondary, visit, status, primary headache, physician, presentation, neck, pattern, mental

Emergency Department and Inpatient Management of Headache in Adults