Effectiveness of Combined Peripheral Nerve Blocks Versus Isolated Greater Occipital Nerve Block in the Management of...

Cluster headache (CH) is a primary headache disorder classified under trigeminal autonomic cephalalgias, characterized by severe, disabling pain attacks. In treatment-resistant cases, where pharmacological interventions are insufficient, peripheral nerve blocks have emerged as a promising interventional option. This study aimed to compare the efficacy of isolated greater occipital nerve (GON) block with combined GON, supraorbital nerve (SON), and sphenopalatine ganglion (SPG) blocks in reducing attack frequency, pain intensity, and treatment response in patients with CH.

This retrospective study included 44 patients diagnosed with CH according to the The International Classification of Headache Disorders, 3rd edition (ICHD-3) criteria, who were treated at Ankara Bilkent City Hospital Neurology Clinics between August 2021 and December 2024.

those who received GON block alone (n=18) and those who underwent combined GON+SON+SPG blocks (n=26). Demographic and clinical data were collected. Attack frequency, pain duration, and Barrow Neurological Institute Pain Scale (BNI-PS) scores were evaluated at baseline, and at the 1st week and 1st month following intervention.

Compared to the GON-only group, patients in the combined block group showed significantly greater reductions in both attack frequency and BNI-PS scores at both follow-up points (p<0.05). Moreover, the duration of pain resolution was significantly shorter in the combined block group (8.96 ± 6.13 days vs. 18.28 ± 17.89 days; p=0.046). No significant differences were found between the groups in terms of baseline demographic or other clinical variables.

Our findings suggest that combined peripheral nerve blocks involving the GON, SON, and SPG are more effective than GON block alone in reducing attack burden and pain duration in patients with CH. This interventional approach may offer a valuable alternative for patients who are unresponsive to conventional medical therapies.