Ultrasound-guided block of the superior cervical ganglion for migraine attacks: a propensity score-matched retrospective study.

Background: This study aimed to examine the efficacy and safety of ultrasound (US)-guided superior cervical ganglion (SCG) block in conjunction with standard triptan in the management of migraine attacks.

Methods: In total, 243 subjects who received an adjunctive US-guided SCG block alongside triptan for a migraine attack were enrolled as the SCG cohort. A 1:1 propensity score based on baseline covariates was used to match 243 cases who received triptan alone as the control. The primary endpoints were pain relief and freedom from pain within 24 h after the procedure. Secondary outcomes included headache relief and freedom from pain within 2 h, monthly migraine days (MMDs), Migraine Disability Assessment (MIDAS) scores, Migraine-Specific Quality of Life questionnaire (MSQ) scores, and adverse events.

Results: The rates of pain relief and freedom from pain at 24 h after the block were increased in the SCG cases compared to the controls {73.3% vs. 49.4%, with mean difference [MD] of 23.9% [95% confidence interval (CI): 15.5%-29.0%] and 64.2% vs. 37.4%, with MD = 26.7% [95% CI: 18.2%-31.3%], respectively}. Superiority was met, as the 95% CI fell within the superiority margin of 15%. Higher rates of pain relief and freedom from pain at 2 h following the procedure were reported in the SCG cohort (both p < 0.001). At the 1-month follow-up, the SCG cohort had a greater improvement in MMDs (p < 0.01), MIDAS scores (p = 0.040), and MSQ scores (p = 0.036). There were no severe adverse events in the SCG group.

Conclusions: US-guided SCG block with triptan was superior to triptan alone in achieving headache remission during a migraine attack for up to 24 h, resulting in reduced migraine days and improved functional ability and life quality at the 1-month follow-up.