目的:评估疗效,以及术后10分钟病人定位的潜在影响,枕大神经(GON)阻滞治疗偏头痛。
方法:前瞻性多中心非盲随机对照试验,随机和治疗60名神经内科门诊患者控制不佳的偏头痛。用头痛冲击试验-6(HIT-6)测量的结果,改良Migraine残疾评估量表(M-MIDAS),和救济得分。
结果:患者定位并未导致RELIEF评分的显着差异(34%vs11%,p值0.10,卡方检验),第90天。当在多元回归分析中考虑时,坐姿显著优于仰卧位(p值0.04)。然而,仰卧位组(n=27)和坐姿组(n=33)之间的HIT-6评分在基线时没有发现显着差异(p值0.76),第30天(p值0.69)或第90天(p值0.54,Mann-WhitneyU检验)。HIT-6评分显着改善了GON阻滞后,仰卧组的中位数为67分(基线前GON)至59分(第30天)和62分(第90天),坐姿组的评分为66分,61分~62分(所有p值≤0.001,组内比较采用Wilcoxon检验);M-MIDAS取得了相似的结局.总的来说,GON阻滞获得了显著的最小临床重要改善,并且GON注射被认为是患者非常耐受的(10cm疼痛评分的中值为2分)。
结论:无论患者位置如何,GON阻滞是一种有效且几乎无痛的偏头痛症状控制方法。与早期发表的观测研究数据不同,本试验得出的结论是,GON后立即患者坐姿是首选.
Assess the efficacy, and potential impact of patient positioning for 10 minutes immediately post-procedure, of greater occipital nerve (GON) block for treatment of migraine.
Prospective multicentre non-blinded randomised controlled trial, randomisation and treatment of 60 neurology clinic patients with poorly controlled migraine. Outcomes measured with Headache Impact Test-6 (HIT-6), modified MIgraine Disability Assessment Scale (M-MIDAS), and RELIEF scores.
Patient positioning did not lead to significant difference in RELIEF score (34% vs 11%, p-value 0.10, Chi-squared test) at day 90. When considered in a multiple regression analysis, the sitting position outperformed supine position significantly (p-value 0.04). However, no significant difference in HIT-6 score between the supine (n = 27) and sitting position groups (n = 33) was detected at baseline (p-value 0.76), day 30 (p-value 0.69) or day 90 (p-value 0.54, Mann-Whitney U-test). The HIT-6 score significantly improved post-GON block, from median 67 (baseline pre-GON) to 59 (day 30) and 62 (day 90) for the supine group and a score of 66, 61-62 for the sitting group (all p-value ≤ 0.001, intra-group comparison using Wilcoxon test); M-MIDAS achieved similar outcomes. Overall, a significant minimal clinically important improvement was obtained with GON block, and the GON injections were deemed very tolerable by patients (median score of 2 on 10 cm pain scale).
Regardless of patient positioning, GON block is an effective and near-painless procedure for migraine symptom control. Unlike earlier published observational study data, this trial concludes that a sitting patient position immediately post-GON is preferred.