Comparison of the effects of greater occipital nerve blockage versus combined greater occipital nerve and supraorbital nerve blockage therapy on sleep, pain, anxiety, depression, and quality of life in chronic migraine.

Objective: This study aimed to evaluate and compare the effects of isolated greater occipital nerve (GON) blockage, combined GON with supraorbital nerve (SON) blockage and control group on sleep quality, pain severity, anxiety and depression, and health-related quality of life (QoL) in individuals with chronic migraine (CM).

Methods: At our clinic, bilateral GON and SON blockage is routinely recommended as a standard treatment for CM patients who either fail to benefit from an effective dose of medical prophylaxis (≥3 months) and discontinue it, or who are unable or unwilling to undergo such treatment. Bilateral application is preferred due to the migratory nature of migraine-type headache localization.Due to the risk/potential of marked tenderness in the forehead region during the procedure or more frequent development of redness and ecchymosis afterward, isolated bilateral GON blockage was performed in patients who did not consent to the SON blockage. Following ethical approval, 80 patients with CM were prospectively assigned to either the GON blockage group (n = 40) or the combined GON and SON blockage group (n = 40). A control group (n = 40) consisting of age- sex- and education- matched healthy individuals was also included. Blockages were performed weekly during the first month and then monthly during the second and third months. All participants completed the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), Visual Analog Scale for Sleep Quality (VAS-Sleep), Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS), Pre-Sleep Arousal Scale (PSAS), Morningness-Eveningness Questionnaire (MEQ), International Restless Legs Syndrome Study Group Rating Scale (IRLSSGS), Visual Analog Scale for Pain (VAS-Pain), Migraine Disability Assessment Scale (MIDAS), Headache Impact Test-6 (HIT-6), Pain Catastrophizing Scale (PCS), Hospital Anxiety and Depression Scale (HADS), Modified Fatigue Impact Scale (MFIS), and the 36-Item Short Form Health Survey (SF-36) at baseline and post-intervention.

Results: In patients who underwent GON blockage, significant improvements were observed in PSQI, ISI, VAS-Sleep, PSAS, VAS-Pain, PCS, MIDAS, HIT-6, HADS, and the SF-36 domains of role limitations-physical, energy/vitality/fatigue, mental health, bodily pain as well as MFIS scores (p < 0.001). Significant improvements compared to baseline were also observed in DBAS, IRLSSGS, and the SF-36 domains of physical functioning, role limitations-emotional, social functioning, physical health, and change in health parameters (p = 0.009, 0.004, 0.002, 0.001, 0.001, 0.005, and 0.001, respectively). In patients who underwent combined GON and SON blockage, significant improvements were observed in ESS, DBAS and the SF-36 domains of physical functioning and role limitations-physical (p = 0.001, 0.031, 0.003, and 0.012, respectively). Additionally, significant improvements compared to baseline were found in PSQI, ISI, VAS-Sleep, PSAS, IRLSSGS, VAS-Pain, PCS, MIDAS, HIT-6, HADS, and the SF-36 domains of role limitations-emotional, energy/vitality/fatigue, mental health, social functioning, bodily pain, physical health, change in health, as well as MFIS scores (p < 0.001). The combined nerve blockages were more effective in enhancing sleep quality, reducing pain and fatigue, and improving psychological well-being and key domains of QoL (p < 0.05).

Conclusion: Despite the short follow-up period, combined GON and SON blockages provided superior clinical outcomes compared with isolated GON blockages, highlighting the therapeutic potential in the management of CM.