Arman Arab1, Masoud Khoshbin2, Elham Karimi3,4, Ghazal Saberian5, Mohammad Saadatnia6, Fariborz Khorvash7. 1. Department of Community Nutrition, School of Nutrition and Food Science, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. 2. Anesthesia and Critical Care Department, Shah Vali Hospital, Azad University of Medical Science, Yazd, Iran. 3. Department of Clinical Nutrition, School of Nutrition and Food Science, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. 4. Research Development Center, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran. 5. School of Medicine, Azad University of Medical Science, Yazd, Iran. 6. Isfahan Neurosciences Research Center, Al Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran. 7. Isfahan Neurosciences Research Center, Al Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran. fkhorvash@gmail.com.
Abstract
AIM: There is a paucity of evidence and consensus on exactly how to carry out the detoxification process. To examine the effect of a greater occipital nerve block (GONB) in the detoxification process, we conducted an open-label, parallel, randomized, controlled clinical trial. MATERIALS AND METHODS: In order to conduct this study, 54 medication-overuse headache (MOH) patients were recruited and allocated randomly to group A (n = 27) or B (n = 27). In both groups, patients underwent detoxification processes without any acute migraine medication or analgesics. During the run-in period, all patients in both groups received the same education, managed by a neurologist and nutritionist. All patients were offered maximally 300 mL of promethazine syrup (5 mg/5 mL) to be taken 10 mg every 8 h during the first 10 days of the study. A 2-mL syringe containing 1 mL of lidocaine 2% and 1 mL of triamcinolone 40 mg/mL was prepared for each patient of group A for conducting GONB. Characteristics of headache attacks, including headache severity, frequency, and duration, were assessed at baseline and after 3 months of intervention. RESULTS: Twenty-six patients in group A (96.3%) and twenty-three in group B (85.2%) completed detoxification, and were thus cured of MOH (P = 0.351). The present study revealed that GONB with local anesthetic and triamcinolone significantly improved the characteristics of headache, including frequency (- 13.66 in group A and - 7.55 in group B), duration (- 7.92 in group A and - 5.88 in group B), and severity (- 3.44 in group A vs. - 1.33 in group B) in group A compared to control (all P value < 0.05). CONCLUSIONS: Although both detoxification programs were effective, detoxification with GONB resulted in better outcomes. TRIAL REGISTRATION: Iranian Registry of Clinical Trials (registration number; IRCT20150906023922N2).
AIM: There is a paucity of evidence and consensus on exactly how to carry out the detoxification process. To examine the effect of a greater occipital nerve block (GONB) in the detoxification process, we conducted an open-label, parallel, randomized, controlled clinical trial. MATERIALS AND METHODS: In order to conduct this study, 54 medication-overuse headache (MOH) patients were recruited and allocated randomly to group A (n = 27) or B (n = 27). In both groups, patients underwent detoxification processes without any acute migraine medication or analgesics. During the run-in period, all patients in both groups received the same education, managed by a neurologist and nutritionist. All patients were offered maximally 300 mL of promethazine syrup (5 mg/5 mL) to be taken 10 mg every 8 h during the first 10 days of the study. A 2-mL syringe containing 1 mL of lidocaine 2% and 1 mL of triamcinolone 40 mg/mL was prepared for each patient of group A for conducting GONB. Characteristics of headache attacks, including headache severity, frequency, and duration, were assessed at baseline and after 3 months of intervention. RESULTS: Twenty-six patients in group A (96.3%) and twenty-three in group B (85.2%) completed detoxification, and were thus cured of MOH (P = 0.351). The present study revealed that GONB with local anesthetic and triamcinolone significantly improved the characteristics of headache, including frequency (- 13.66 in group A and - 7.55 in group B), duration (- 7.92 in group A and - 5.88 in group B), and severity (- 3.44 in group A vs. - 1.33 in group B) in group A compared to control (all P value < 0.05). CONCLUSIONS: Although both detoxification programs were effective, detoxification with GONB resulted in better outcomes. TRIAL REGISTRATION: Iranian Registry of Clinical Trials (registration number; IRCT20150906023922N2).