Chronic paroxysmal hemicrania and hemicrania continua: anaesthetic blockades of pericranial nerves

Greater occipital nerve (GON), supraorbital nerve (SON), and minor occipital nerve (MON) blockades-in this sequence-were carried out on the symptomatic side in patients with chronic paroxysmal hemicrania (CPH) (no = 6) and hemicrania continua (HC) (no = 7). Prior to the blockade, indomethacin was discontinued for a sufficiently long time (24 h) to allow a constant flow of attacks/constant pain. The local anaesthetic agent used was lidocaine. The blockades were invariably negative in CPH. In HC, the GON and MON blockades generally had no positive influence. The pattern as regards SON blockades was slightly different, in that the pre-test average VAS-value of 7.3 decreased to 4.6 (p < 0.05, Student's t-test, and p = 0.065 Wilcoxon) and-on an individual basis-decreased in 4 out of 7 patients. GON/MON blockades will help distinguish CPH/HC from cervicogenic headache. SON blockade will have to be carried out in a good-sized series of HC patients in order to establish more concrete evidence of the putative effect in HC. SON blockades may eventually also aid in the distinction between HC and supraorbital nerve neuralgia (where the blockade effect generally seems to be complete).