Greater occipital nerve block for chronic headache management in children and adolescents: a longitudinal observational study and systematic review

Treatment options for children and adolescents with chronic headache are limited. Greater occipital nerve block (GONB) has been shown to be effective in headache relief in adults, with minimal side effects, whereas similar evidence for pediatric patients remains to be determined. This study was undertaken to assess the effectiveness, acceptability, and tolerability of GONB in the management of chronic headache in children and adolescents, based on our own clinic experience and a systematic review of the literature. This longitudinal observational study included all children and adolescents with chronic headache who received GONB at a large tertiary hospital for children between February 2018 and June 2024. Patients were given 10 mg lidocaine with 40 mg methylprednisolone on one or both sides. Data were collected on patients' demographics, clinical diagnosis of the headache disorder, previous treatments, GONB procedure details, response to the treatment, and reported adverse reactions. Diagnoses of headache disorders were made based on the International Classification of Headache Disorders, 3rd edition. A good response was defined as resolution of headache for at least 2 weeks, whereas a partial response was defined as relief of headache lasting less than 2 weeks or a reduction in headache intensity. Statistical analysis assessed responses to the first procedure and all subsequent treatment sessions separately. The findings from this study were analyzed alongside similar original data from published clinical trials, case series, and case reports on the use of GONB in the treatment of patients younger than 18 years with chronic headache, utilizing the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist. Ninety-eight patients aged 10-17 years, 75 of 98 (77%) female, with chronic headache were given 164 treatment sessions of GONB over a 6-year period. In 53 of 164 (32%) cases, GONB was administered on one side, whereas 111 of 164 (68%) patients received the injections on both sides. One hundred five of 164 (64%) treatment sessions resulted in a good or partial response (84/164 [51%] and 21/164 [13%], respectively). A positive response to GONB was associated with a diagnosis of chronic or episodic migraine and younger age of patients at the first treatment. Furthermore, the response to the first treatment was predictive of responses to the subsequent injections. The procedure was well tolerated, with only mild to moderate adverse reactions in 33 of 164 (20%) treatment sessions. A systematic review showed that GONB was predominantly used for children with chronic migraine and demonstrated an effectiveness rate of 67%. GONB is a safe, well-tolerated, and effective treatment option for children and adolescents with chronic headaches, particularly migraine. [Abstract copyright: © 2025 American Headache Society.]