• Giorgio Lambru, Susie Lagrata, and Manjit S Matharu.
• Headache Group, Institute of Neurology and the National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
• Headache. 2012 Nov 1;52(10):1596-9.

AbstractGreater occipital nerve (GON) infiltration is widely used for the treatment of primary and secondary headache disorders mainly on the basis of open-label evidence, although recent double-blinded placebo-controlled trials have demonstrated its efficacy in cluster headache. The procedure is generally well tolerated although corticosteroid-related side effects, including Cushing's syndrome and local cutaneous changes, can occur. We report the occurrence of cutaneous atrophy and alopecia in 4 patients who underwent GON blockade with triamcinolone and lidocaine. Triamcinolone injection is associated with cutaneous atrophy, especially in superficial injection sites; therefore, alternative steroid preparations like methylprednisolone and betamethasone might be more appropriate for GON blockade.© 2012 American Headache Society.

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