CT-guided infiltration of greater occipital nerve for refractory craniofacial pain syndromes other than occipital neuralgia

Purpose: The purpose of this study was to evaluate the effectiveness of computed tomography (CT)-guided infiltration of greater occipital nerve (GON) for the treatment of refractory craniofacial pain syndromes other than occipital neuralgia. Materials and methods: Fifty-six patients suffering from refractory craniofacial pain syndromes were included between 2011 and 2017. There were 33 women and 23 men with a mean age of 50.7 years +/- 13.1 (SD) (range: 27-74 years). CT-guided infiltration was performed at the intermediate site of the GON with local anesthetics and cortivazol. Twenty-six (26/56; 46%) patients suffered from chronic migraine, 14 (14/56; 25%) from trigeminal neuralgia and 16 (16/56; 29%) from cluster headaches. Clinical success at 1, 3, and 6 months was defined by a decrease of at least 50% of pain as assessed using visual analog scale (VAS). Results: Mean overall VAS score before infiltration was 8.7 +/- 1.3 (SD) (range: 6 - 10). Mean overall VAS scores after infiltration were 2.3 +/- 3 (SD) (range: 0 - 10) (P< 0.01) at one month, 3.5 +/- 3.3 (SD) (range: 0 10) (P< 0.01) at three months and 7.6 +/- 1.3 (SD) (range: 1-10) (P< 0.01) at six months. After infiltration, clinical success was achieved in 44 patients (44/56; 78.5%) at 1 month, 37 patients (37/56; 66%) at 3 months and 13 patients (13/56; 23%) at 6 months. Clinical success according to the clinical presentation were as follows: 88% (23/26) at one month, 73% (19/26) at 3 months, and 23% (6/26) at 6 months in patients with chronic migraine, 81% (13/16), 69% (11/16) and 31% (5/16) in those with cluster headaches and 57% (8/14), 50% (7/14) and 14% (2/14) in those with trigeminal neuralgia. No major complications due to CT-guided GON infiltration were reported in any patient. Conclusion: CT-guided infiltration at the intermediate site of the GON appears as an effective treatment of craniofacial pain syndromes especially in patients with chronic migraine and those with cluster headaches. (C) 2020 Published by Elsevier Masson SAS on behalf of Societe francaise de radiologie.