title: Outcomes of greater occipital nerve injections in pediatric patients with chronic primary headache disorders.
abstract: BACKGROUND
  Chronic migraine is common in pediatrics and generally disabling. In adults, infiltration of the area around the greater occipital nerve can provide short- to medium-term benefit in some patients. This study reports the efficacy of greater occipital nerve infiltrations in pediatric patients with chronic primary headache disorders.
  
  
  METHODS
  Retrospective chart review of patients <18 years with a chronic primary headache disorder undergoing a first-time injection. Infiltrations were unilateral and consisted of a mixture of methylprednisolone acetate, adjusted for weight, and lidocaine 2%.
  
  
  RESULTS
  Forty-six patients were treated. Thirty-five (76%) had chronic migraine, 9 (20%) new daily persistent headache (NDPH), and 2 (4%) a chronic trigeminal autonomic cephalalgia. Medication overuse was present in 26%. Ages ranged from 7 to 17 years. Follow-up data were available for 40 (87%). Overall, 53% (21/40) benefitted, and 52% (11/21) benefitted significantly. Benefit onset ranged from 0 to 14 days, mean 4.7 (SD 4.3), with mean benefit duration of 5.4 (SD 4.9) weeks. In chronic migraine, 62% (18/29) benefitted, and 56% (10/18) significantly benefitted. In NDPH, 33% (3/9) benefitted; 33% (n = 1) significantly. Neither child with a chronic trigeminal autonomic cephalalgia benefitted. In logistic regression modeling, medication overuse, age, sex, and sensory change in the distribution of the infiltrated nerve did not predict outcome. There were no serious side effects.
  
  
  CONCLUSIONS
  Greater occipital nerve injections benefitted 53% of pediatric patients with chronic primary headache disorders. Efficacy appeared greater in chronic migraine than NDPH. Given the benign side effect profile, a greater occipital nerve infiltration seems appropriate before more aggressive approaches.
authors.affiliation: Headache Center, University of California, San Francisco, San Francisco, California; Division of Child Neurology, University of California, San Francisco, San Francisco, California. Electronic address: GelfandA@neuropeds.ucsf.edu.
authors.forename: Amy A
authors.initials: AA
authors.lastname: Gelfand
authors.affiliation: School of Medicine, University of California, San Francisco, San Francisco, California.
authors.forename: Amanda C
authors.initials: AC
authors.lastname: Reider
authors.affiliation: Headache Center, University of California, San Francisco, San Francisco, California.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Goadsby
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002908:Chronic Disease / Q000188:drug therapy; D005260:Female; D005500:Follow-Up Studies; D051270:Headache Disorders, Primary / Q000188:drug therapy*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000077555:Methylprednisolone Acetate; D008881:Migraine Disorders / Q000188:drug therapy; D016017:Odds Ratio; D018373:Peripheral Nervous System Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D012189:Retrospective Studies; D012737:Sex Factors; D013127:Spinal Nerves; D013997:Time Factors; D016896:Treatment Outcome; D051303:Trigeminal Autonomic Cephalalgias / Q000188:drug therapy
chemical_list: D018373:Peripheral Nervous System Agents; D000077555:Methylprednisolone Acetate; D008775:Methylprednisolone
keywords: NDPH; medication overuse headache; pediatric headache; pediatric migraine