The comparative clinical effectiveness of withdrawal treatment with greater occipital nerve block at the C2 level with dexamethasone or bupivacaine in medication-overuse headache

Objectives: This study aimed to evaluate the clinical effectiveness of withdrawal treatment combined with greater occipital nerve (GON) block at the C2 level using dexamethasone or bupivacaine in patients with medication-overuse headache (MOH). Patients and methods: The retrospective study was conducted with 78 patients (17 males, 61 females; mean age: 40.56±12.52 years; range, 25 to 63 years) with MOH who were admitted between October 2022 and April 2024. Patients were divided into three groups: Group A (n=21) received a standard withdrawal protocol with limited use of triptans and nonsteroidal anti-inflammatory drugs, Group B (n=27) received a GON blockade with a single administration of dexamethasone and bupivacaine, and Group C (n=30) received weekly GON blockades with bupivacaine for four weeks. Comprehensive headache diaries were used to collect data on headache severity, medication usage, and headache duration before and after treatment. Results: Group A showed significant reductions in severe headache intensity, mean Visual Analog Scale (VAS) scores, migraine-related headaches, and medication usage in the third and fourth weeks after treatment. Group B demonstrated significant decreases in severe headaches, mean VAS scores, and headache days by the third month. Group C exhibited significant reductions in headache severity, VAS scores, and headache frequency over four weeks. All groups showed a decrease in headache days per month, with Group C showing the most consistent improvement. Conclusion: The study concluded that GON blockade, both as a single administration and in repeated weekly doses, was an effective treatment for MOH. The combined approach of withdrawal protocol and GON blockade significantly reduced headache severity, medication usage, and headache frequency, offering a promising treatment strategy for patients with MOH.