Research Summary

Ultrasound-Guided Nerve Blocks Show Comparable Efficacy in Chronic Resistant Migraine, Added Benefits in Select Patients

Kate Young

Key Highlights

  • Both ultrasound-guided sphenopalatine ganglion (SPG) and greater occipital nerve (GON) blocks significantly improved headache parameters in chronic resistant migraine.
  • No significant difference in efficacy was observed between SPG and GON blocks overall.
  • SPG block showed enhanced efficacy in patients with cranial autonomic symptoms and temporal pain.

Ultrasound-guided nerve blocks targeting either the sphenopalatine ganglion (SPG) or the greater occipital nerve (GON) significantly improved headache frequency, intensity, and associated disability in patients with chronic resistant migraine. Both interventions demonstrated equivalent efficacy on clinical outcomes assessed by headache diaries, HIT-6, and MIDAS scores. However, SPG block may offer added benefit in individuals experiencing cranial autonomic symptoms or those with a temporal location of pain.

Chronic resistant migraine remains a treatment challenge, especially in patients unresponsive or intolerant to conventional pharmacologic approaches. Peripheral nerve blocks have emerged as promising alternatives, offering targeted analgesia and reduced systemic side effects. While the GON block is well-studied, less is known about the comparative effectiveness of SPG blocks, particularly when guided by ultrasound and applied via the infra-zygomatic approach. This study addresses a key clinical gap by evaluating the efficacy and safety of these two interventional modalities in a directly comparative framework.

This randomized controlled trial included 53 adults with chronic resistant migraine who had failed at least three lines of effective therapy. Patients were allocated to receive either bilateral ultrasound-guided SPG block (n = 22), bilateral GON block (n = 21), or a sham SPG block (n = 10). Baseline assessments included headache diaries, HIT-6, and MIDAS scores. Follow-ups occurred at 1 month for headache diary parameters and HIT-6, and at 3 months for MIDAS outcomes. Interventions used long-acting steroids with lidocaine under real-time ultrasound guidance to optimize safety and target accuracy.

Both SPG and GON block groups showed significant improvement in headache frequency, duration, intensity, and total pain burden at 1 month compared with sham, with no significant differences between the active treatment arms. Similarly, both interventions significantly reduced HIT-6 and MIDAS scores. Among patients with cranial autonomic symptoms, SPG block demonstrated superior efficacy over GON block. Additionally, SPG block tended to be more effective for temporal pain, while GON block favored occipital pain, though these location-specific differences did not reach statistical significance.

The study was limited by small sample size, suggesting the need for larger sample studies to identify subgroups of patients who could benefit from these techniques.

“Both GON block and SPG block were effective in improving patients with chronic resistant migraine, with significant and clinically meaningful reduction in headache frequency, intensity and in reducing functional impairment, the study authors concluded. “There were no significant differences in efficacy between the two techniques and both were reasonably safe.”

Reference:
Taha NA, Fathy M, Elsadek A, et al. Efficacy and safety of ultrasound-guided peripheral nerve blocks in management of chronic resistant migraine. J Headache Pain. 2025;26(1):80. Published 2025 Apr 16. doi:10.1186/s10194-025-02013-3