• Narayan R Kissoon, Travis G O'Brien, Markus A Bendel, Jason S Eldrige, Jonathan M Hagedorn, William D Mauck, Susan M Moeschler, Oludare O Olatoye, Thomas P Pittelkow, James C Watson, and Matthew J Pingree.
• Division of Pain Medicine, Department of Anesthesiology.
• Clin J Pain. 2022 Feb 7; 38 (4): 271278271-278.

ObjectivesThe purpose of this single center, prospective randomized controlled trial was to compare clinical outcomes between an ultrasound-guided greater occipital nerve block (GONB) at the C2 vertebral level versus landmark-based GONB at the superior nuchal line.MethodsPatients with occipital neuralgia or cervicogenic headache were randomized to receive either a landmark-based GONB with sham ultrasound at the superior nuchal line or ultrasound-guided GONB at the C2 vertebral level with blinding of patients and data analysis investigators. Clinical outcomes were assessed at 30 minutes, 2 weeks, and 4 weeks postinjection.ResultsThirty-two patients were recruited with 16 participants in each group. Despite randomization, the ultrasound-guided GONB group reported higher numeric rating scale (NRS) scores at baseline. Those in the ultrasound-guided GONB group had a significant decrease in NRS from baseline compared with the landmark-based GONB group at 30 minutes (change of NRS of 4.0 vs. 2.0) and 4-week time points (change of NRS of 2.5 vs. -0.5). Both groups were found to have significant decreases in Headache Impact Test-6. The ultrasound-guided GONB had significant improvements in NRS, severe headache days, and analgesic use at 4 weeks when compared with baseline. No serious adverse events occurred in either group.ConclusionsUltrasound-guided GONBs may provide superior pain reduction at 4 weeks when compared with landmark-based GONBs for patients with occipital neuralgia or cervicogenic headache.Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

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