Greater occipital nerve blocks may alleviate photophobia brought on by migraines

SPAIN: According to a research study published in the Journal of Neuro-Ophthalmology, greater occipital nerve block reduces migraine-related photophobia as judged by the Utah Photophobia Symptom Impact Scale (UPSIS-12) and the Korean Photophobia Questionnaire (KUMC-8).

One of the most unpleasant symptoms experienced by migraine sufferers is photophobia. Up to 80% of migraine sufferers experience photophobia, which can occur between attacks. There aren't many studies looking at how migraine medication affects this symptom. The majority of the proposed therapies for photophobia up to this point have been based on case reports or a small amount of research. In order to alleviate this troublesome sensation, new treatments are still required.

The researchers of this study sought to investigate how levels of photophobia associated with migraines were affected by greater occipital nerve (GON) block.

The researchers carried out a prospective observational case-control study. They sought migraine and photophobic patients who visited a headache clinic. Patients who underwent a GON block while adhering to standard clinical practice standards were considered cases. 41 patients were included in the trial, of which 28 (68.3%) were cases and 13 (31.7%) were controls. All patients were assessed during their initial visit (V1) and one week later (V2) using the Hospital Anxiety and Depression Scale, the Migraine Specific Quality of Life Questionnaire, the Utah Photophobia Symptom Impact Scale (UPSIS-12), and the Korean Photophobia Questionnaire (KUMC-8).

Conclusive points of the study:

• At V1, neither the median [p25-p75] score of the UPSIS-12 in cases vs controls (32.0 [21.0-34.0] vs 30.5 [22.0-37.0], P = 0.497) nor the KUMC-8 (6.5 [5.5-7.0] vs 7.0 [6.0-8.0], P = 0.463) showed any discernible differences.
• When compared to the control group, patients saw a significant improvement in UPSIS-12 of 5.5 [8.8 to 1.3] and in KUMC-8 of 0.5 [2.0 to 0] at V2.
• Even though statistical validity was not attained (P = 0.643 and P = 0.122, respectively), migraine patients with aura had higher UPSIS-12 scores at V1 (33.5 [24.5-37.0] vs 26.0 [16.0-35.0]) and showed less improvement at V2 after GON block than migraine patients without aura (4.0 [6.0 to 1.0] vs 8.0 [17.0 to 2.0]).
• The remaining scales showed no appreciable variance.

The greater occipital nerve (GON) block's potential therapeutic value in treating individuals with migraine-related photophobia was examined in this article for the first time. Notably, GON block reduced migraine-related photophobia in treated patients compared to controls, particularly in those with migraine without aura.

The authors came to the conclusion that GON block would be a clinically helpful strategy for treating patients with migraine-related photophobia.

REFERENCE

Membrilla, Javier A. MD; de Lorenzo, Íñigo MD; Sánchez-Casado, Lucía MD; Sastre, María MD; Díaz de Terán, Javier MD. Impact of Greater Occipital Nerve Block on Photophobia Levels in Migraine Patients. Journal of Neuro-Ophthalmology: September 2022 - Volume 42 - Issue 3 - p 378-383 doi: 10.1097/WNO.0000000000001541