Do nerve blocks boost mood and functional activity in patients with chronic migraine and medication overuse headache?

Background and purpose: Chronic migraine (CM) and medication overuse headache (MOH) present significant therapeutic challenges, often accompanied by mood disturbances and functional impairment. Although prophylactic drug therapies remain essential, adjunct interventions such as Greater Occipital Nerve (GON) and Supraorbital Nerve (SON) blocks may offer additional benefits. This study aimed to assess whether adding these nerve blocks to standard medication prophylaxis could improve mood and functionality in patients diagnosed with CM or MOH.

Methods: A retrospective analysis was conducted on 147 patients (131 females, 16 males) treated between December 2020 and March 2021. The patients were divided into three groups: prophylactic pharmacotreatment alone, prophylactic treatment with GON block, and prophylactic treatment with combined GON and SON blocks. Following this, pain and functionality metrics were assessed using Visual Analog Scale (VAS), Migraine Disability Assessment Scale (MIDAS) and Beck Depression Inventory (BDI) scores. Statistical analyses utilized the Statistical Package for the Social Sciences (SPSS) and R software for non-parametric longitudinal data evaluation.

Results: Among the 147 patients analysed for this study, GON + SON blocks significantly reduced VAS scores from week 2 onwards (Mann-Whitney U test p = 0.021), demonstrating faster improvement compared to other treatment groups. MIDAS scores significantly improved across all groups, with the combined GON + SON blocks show- ing the most pronounced reduction (Wald Time Statistic [WTS] = 1262.52, p < 0.01). BDI scores decreased significantly over time (WTS = 997.89, p < 0.01), though no treatment-specific superiority was observed. Minimal and manageable minor complications were reported, confirming procedural safety.

Conclusion: Adding GON and SON blocks to prophylactic drug treatment enhances pain reduction and functionality in CM and MOH patients. Combined blocks yield faster, significant benefits, with VAS improvements from the second week. BDI scores improved across all groups, though mood-related gains require further study. In the future multicenter randomized controlled trials are needed.