Predictors of GON Blockade Success in Migraine

Official title

Predictive Factors for the Success of Greater Occipital Nerve Block in Migraine: A Multicenter Prospective Study

Overview

This multicenter, prospective cohort study aims to identify clinical and demographic predictors that influence the success of greater occipital nerve (GON) block in patients with migraine. Patients will be evaluated at baseline, on each injection day, and at one- and three-month follow-ups. Study parameters include demographics, migraine type and duration, comorbidities, headache characteristics, treatment history, and validated outcome measures such as the Numeric Rating Scale (NRS), Headache Impact Test-6 (HIT-6), and Global Rating of Change (GRoC). The goal is to establish predictive factors of treatment success in order to optimize patient selection and contribute robust multicenter evidence to individualized migraine management

Interventions

• Procedure Greater Occipital Nerve (GON) Blockade
  The greater occipital nerve block (GONB) will be performed using anatomical landmarks (distal approach). The injection point is located at the medial one-third of the line between the external occipital protuberance and the mastoid process. A 26-gauge insulin needle will be used for the procedure. The block will be administered bilaterally with 0.5% bupivacaine, 1.5 ml per side (total 3 ml). The intervention will be repeated once weekly for a total of four sessions

Primary outcome measures

• Number of days with headache [Time frame: Baseline,1st month and 3rd month]

Secondary outcome measures (6)

• The 6-Item Headache Impact Test (HIT-6) [Time frame: Baseline,1st month and 3rd month]
• Global Rating of Change (GROC) [Time frame: 1st month and 3rd month]
• Numeric Rating Scale [Time frame: Baseline,1st month and 3rd month]
• Number of migraine attacks [Time frame: Baseline, 1st month and 3rd month]
• Duration of migraine attacks [Time frame: Baseline, 1st month and 3rd month]
• Analgesic consumption [Time frame: Baseline, 1st month and 3rd month]

Eligibility criteria

Inclusion criteria

• Diagnosis of migraine for at least 6 months, according to ICHD-3 criteria
• Age between 18 and 65 years
• Inadequate response to preventive therapy used regularly for at least 3 months
• Planned treatment with greater occipital nerve block (GONB) and provision of signed informed consent
• Receiving GONB treatment for the first time

Exclusion criteria

• Pregnancy or breastfeeding
• Presence of malignancy
• Coagulopathy or anticoagulant therapy
• Local infection, open wound, or history of surgery at the injection site preventing the procedure
• History of severe neurological or psychiatric disorders
• Receipt of interventional treatment (e.g., Botox, acupuncture, neural therapy, nerve blocks) within the last 3 months
• Use of steroids or immunosuppressive therapy
• Start of a new preventive therapy within the last 3 months
• Inability to comply with keeping a headache diary
• Known hypersensitivity or allergy to bupivacaine

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

N/A

Model

Single group

Masking

Open label

Primary purpose

Treatment

Study locations

Turkey (Türkiye) · 1 center

• Başakşehir Çam and Sakura City Hospital — Istanbul

Identifiers

NCT: NCT07170111 · 25.06.2025.242

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗