Does Greater Occipital Nerve Block Modulate Brainstem Excitability? Insights From a Randomized Controlled Study in Migraine.

IF 3.5 3区医学 Q2 CLINICAL NEUROLOGY

Neuromodulation Pub Date : 2025-06-18 DOI:10.1016/j.neurom.2025.04.010

Ahmet Başarı, İlker Arslan, Çağrı Cansu, Güngör Enver Özgencil, Levent Özbek, Bülent Cengiz

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引用次数: 0

Abstract

Objectives: Greater occipital nerve block (GONb) is widely used in the treatment of migraine; however, its effects on brainstem excitability remain unclear. This study aimed to assess whether GONb alters brainstem excitability in patients with migraine by evaluating blink reflex (BR) and masseter inhibitory reflex (MIR) parameters.

Materials and methods: This randomized, placebo-controlled, double-blind study included 34 patients with migraine who received either GONb (n = 17) or placebo (n = 17). BR and MIR responses were recorded before and after treatment. The primary outcome was the change in BR R2 response latency, whereas secondary outcomes included BR inhibition, MIR parameters, and pain reduction (visual analog scale [VAS] scores).

Results: GONb significantly reduced BR R2 response latency (p = 0.002), indicating altered brainstem excitability. However, no significant changes were observed in BR inhibition (p > 0.05) or MIR parameters (p > 0.05). GONb led to a significant reduction in migraine frequency (-84.6%, p < 0.0001) and pain severity (VAS: 7.2 ± 1.1 to 2.3 ± 1.6, p < 0.0001), but these improvements did not correlate with neurophysiologic findings.

Conclusions: This study reveals that GONb modifies brainstem excitability by affecting BR R2 latency but does not significantly affect BR inhibition or MIR responses. The findings suggest that GONb selectively influences trigeminal nociceptive pathways rather than global brainstem inhibitory circuits. Further studies with larger cohorts and longer follow-up are needed to elucidate the broader neurophysiologic effects of GONb in migraine.

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枕大神经阻滞是否调节脑干兴奋性？来自偏头痛随机对照研究的见解。

目的：枕大神经阻滞（GONb）在偏头痛治疗中应用广泛；然而，其对脑干兴奋性的影响尚不清楚。本研究旨在通过评估眨眼反射（BR）和咬咬抑制反射（MIR）参数来评估GONb是否改变偏头痛患者的脑干兴奋性。材料和方法：这项随机、安慰剂对照、双盲研究包括34例偏头痛患者，他们接受GONb （n = 17）或安慰剂（n = 17）。记录治疗前后BR、MIR反应。主要结局是BR R2反应潜伏期的变化，而次要结局包括BR抑制、MIR参数和疼痛减轻（视觉模拟量表[VAS]评分）。结果：GONb显著降低了BR R2反应潜伏期（p = 0.002），表明脑干兴奋性发生改变。然而，在BR抑制（p > 0.05）或MIR参数（p > 0.05）方面未观察到显著变化。GONb导致偏头痛频率（-84.6%,p < 0.0001）和疼痛严重程度（VAS: 7.2±1.1至2.3±1.6,p < 0.0001）显著降低，但这些改善与神经生理学结果无关。结论：本研究揭示GONb通过影响BR R2潜伏期改变脑干兴奋性，但对BR抑制或MIR反应无显著影响。研究结果表明，GONb选择性地影响三叉神经伤害感觉通路，而不是整个脑干抑制回路。进一步的研究需要更大的队列和更长时间的随访来阐明GONb在偏头痛中的更广泛的神经生理作用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neuromodulation 医学-临床神经学

CiteScore

6.40

自引率

3.60%

发文量

978

审稿时长

54 days

期刊介绍： Neuromodulation: Technology at the Neural Interface is the preeminent journal in the area of neuromodulation, providing our readership with the state of the art clinical, translational, and basic science research in the field. For clinicians, engineers, scientists and members of the biotechnology industry alike, Neuromodulation provides timely and rigorously peer-reviewed articles on the technology, science, and clinical application of devices that interface with the nervous system to treat disease and improve function.