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Steroids in Occipital Nerve Block for Treatment of Headache

Phase 4
Recruiting
Conditions
Headache
Occipital Nerve Block
Interventions
Drug: Bupivacaine
Drug: Lidocaine
Drug: Normal saline
Drug: Dexamethasone
Procedure: Greater/lesser occipital nerve blocks
Registration Number
NCT05732532
Lead Sponsor
Mayo Clinic
Brief Summary

Currently there is limited evidence of benefit for the addition of steroids to occipital nerve blocks for treatment of headache, and not all steroids have been explored. The purpose of this research is to learn more about whether the addition of a specific kind of steroid (dexamethasone) provides any additional benefit to nerve blocks.

Detailed Description

Patients who are referred by their neurology provider for occipital nerve block as treatment of headache according to current accepted standard of care will be considered for this study. Baseline data will be obtained from the patients prior to proceeding with their nerve block and their headache diagnosis will be recorded based on electronic medical record review. Patients will be randomized to one of two treatment arms, anesthetic with dexamethasone or anesthetic without dexamethasone. The injectate will be the same color and amount of solution for each trial arm. Thus, the neurology provider performing the injection remains blinded and the patient remains blinded.

Injection sites will be inspected to ensure no active bleeding, infection, cranial bone or cervical spine defects/prior surgeries that prohibit safe use of landmark-based technique. A neurologist who is experienced at performing nerve blocks will administer the injections to the bilateral greater and lesser occipital nerves using the landmark-based technique. The occipital protuberance and mastoid process are palpated, with the location of the greater occipital nerve at approximately 1/3 the distance laterally and the lesser occipital nerve at approximately 2/3 the distance laterally along the nuchal ridge for a total of 4 injection sites.

Patients will be observed for approximately 10 minutes after the procedure to monitor for any immediate adverse effects and to ensure that anesthesia in the distribution of the injected nerves was achieved. Then, they will be instructed to keep a headache diary after treatment and will be provided a written example diary. A study staff who remains blinded to the patient's trial arm (but not necessarily the neurology provider who performed the injection) will contact the patients via telephone at 1, 2 and 4 weeks to assess response to treatment.

Recruitment & Eligibility

Status
RECRUITING
Sex
All
Target Recruitment
120
Inclusion Criteria
  • Treated for headache including but not limited to occipital neuralgia, episodic migraine, chronic migraine and/or cervicogenic headache.
  • Stable on preventative medication dosing for at least 1 month prior to occipital nerve block and no change in preventative medication regimen during the course of the study.
  • Able to understand the requirements of the study and return for treatment.
  • Able to independently provide informed consent.
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Exclusion Criteria
  • Diagnosis of cluster headache according to the International Classification of Headache Disorders 3rd edition.
  • Occipital or other cranial nerve block administered within 3 months prior to initiation of study.
  • History of adverse reaction or contraindication to any of the study ingredients (bupivacaine, lidocaine, dexamethasone).
  • Pregnancy.
  • Infection or bleeding at site of injection.
  • Cranial bone or cervical spine defects/prior surgeries near injection site that prohibit use of landmark-based technique.
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Study & Design

Study Type
INTERVENTIONAL
Study Design
PARALLEL
Arm && Interventions
GroupInterventionDescription
Anesthetic without steroid groupBupivacaineSubjects scheduled for bilateral greater/lesser occipital nerve blocks as part of clinical care will receive standard of care medication, including lidocaine and bupivacaine and normal saline.
Anesthetic without steroid groupNormal salineSubjects scheduled for bilateral greater/lesser occipital nerve blocks as part of clinical care will receive standard of care medication, including lidocaine and bupivacaine and normal saline.
Anesthetic without steroid groupGreater/lesser occipital nerve blocksSubjects scheduled for bilateral greater/lesser occipital nerve blocks as part of clinical care will receive standard of care medication, including lidocaine and bupivacaine and normal saline.
Anesthetic with dexamethasone groupBupivacaineSubjects scheduled for bilateral greater/lesser occipital nerve blocks as part of clinical care will receive standard of care medication, including lidocaine and bupivacaine and dexamethasone.
Anesthetic with dexamethasone groupGreater/lesser occipital nerve blocksSubjects scheduled for bilateral greater/lesser occipital nerve blocks as part of clinical care will receive standard of care medication, including lidocaine and bupivacaine and dexamethasone.
Anesthetic without steroid groupLidocaineSubjects scheduled for bilateral greater/lesser occipital nerve blocks as part of clinical care will receive standard of care medication, including lidocaine and bupivacaine and normal saline.
Anesthetic with dexamethasone groupLidocaineSubjects scheduled for bilateral greater/lesser occipital nerve blocks as part of clinical care will receive standard of care medication, including lidocaine and bupivacaine and dexamethasone.
Anesthetic with dexamethasone groupDexamethasoneSubjects scheduled for bilateral greater/lesser occipital nerve blocks as part of clinical care will receive standard of care medication, including lidocaine and bupivacaine and dexamethasone.
Primary Outcome Measures
NameTimeMethod
Headache days 1 week following treatment1 week

Number of self-reported days subjects experience headaches in the past week following treatment

Headache days 2 weeks following treatment2 weeks

Number of self-reported days subjects experience headaches in the past weeks following treatment

Headache days 4 weeks following treatment4 weeks

Number of self-reported days subjects experience headaches in the past weeks following treatment

Secondary Outcome Measures
NameTimeMethod
Headache Severity1 week, 2 weeks, 4 weeks

Self-reported average severity of subjects' headaches using a scale of 0-10, with 0=no pain and 10=worst pain possible following treatment

Moderate or severe headache days1 week, 2 weeks, 4 weeks

Number of self-reported days subjects report headaches as being moderate or severe following treatment

Acute medication use1 week, 2 weeks, 4 weeks

Number of self-reported days subject had to take acute pain medication for their headaches following treatment

Location of headache1 week, 2 weeks, 4 weeks

Self-reported location of headache (front, back, other) following treatment

Trial Locations

Locations (1)

Mayo Clinic Minnesota

🇺🇸

Rochester, Minnesota, United States

Mayo Clinic Minnesota
🇺🇸Rochester, Minnesota, United States
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