Ultrasound-guided stellate ganglion block for the treatment of migraine in elderly patients: A retrospective and observational study.
effectiveness
elderly
migraine
retrospective study
stellate ganglion block
Journal
Headache
ISSN: 1526-4610
Titre abrégé: Headache
Pays: United States
ID NLM: 2985091R
Informations de publication
Date de publication:
06 2023
06 2023
Historique:
revised:
25
04
2023
received:
08
03
2023
accepted:
28
04
2023
medline:
21
6
2023
pubmed:
14
6
2023
entrez:
14
6
2023
Statut:
ppublish
Résumé
This study aimed to assess the effectiveness and safety of ultrasound-guided stellate ganglion block (SGB) in the prophylactic treatment of migraine in the elderly. Treatment of migraine in the elderly is often difficult and troublesome due to multiple comorbidities, drug interactions, and adverse effects (AEs). SGB may be an effective treatment approach for migraine in the elderly as its clinical use is rarely limited by concomitant diseases and age-related physiological changes; however, no studies have evaluated the effectiveness of SGB in the treatment of migraine in the elderly population. This is a retrospective observational case series study. We retrospectively analyzed patients with migraine aged ≥65 years, who underwent ultrasound-guided SGB for headache management between January 2018 and November 2022. Pain intensity using the numerical rating scale (NRS, 0-10), number of days with headache per month, duration of headache, and the consumptions of acute medications were recorded before SGB treatment, and at 1, 2, and 3 months after the last SGB. Safety assessment included thorough documentation of serious and minor AEs related to SGB. Of 71 patients, 52 were analyzed in this study. After the final SGB, the NRS scores decreased significantly from a mean (± standard deviation [SD]) of 7.3 (1.2) at baseline to 3.3 (1.4), 3.1 (1.6), and 3.6 (1.6) at 1, 2, and 3 months, respectively (vs. baseline, p < 0.001). The mean (SD) number of headache days per month significantly reduced from 23.1 (5.5) to 10.9 (7.1) (p < 0.001), 12.7 (6.5) (p = 0.001), and 14.0 (6.8) days (p = 0.001) at the 1-, 2-, and 3-month follow-ups, respectively. The values of headache duration were also significantly lower at the 1-month (mean [SD] 12.5 [15.8] h, p = 0.001), 2-month (mean [SD] 11.3 [15.9] h, p = 0.001), and 3-month follow-ups (mean [SD] 14.3 [16.0] h, p = 0.001) compared to pre-treatment baseline (mean [SD] 22.7 [17.1] h). There were 33/52 (64%) patients experiencing at least a 50% reduction in acute medications consumption 3 months after the final SGB treatment. The overall AEs rate associated with ultrasound-guided SGB was 9.0% (26/290 SGBs). There were no serious AEs; all reported AEs were minor and transient. Stellate ganglion block treatment could reduce pain intensity, headache frequency, and duration of migraine, thereby reducing the need for adjunctive medications in elderly patients. Ultrasound-guided SGB might be a safe and effective intervention for the treatment of migraine in elderly patients.
Sections du résumé
OBJECTIVES
This study aimed to assess the effectiveness and safety of ultrasound-guided stellate ganglion block (SGB) in the prophylactic treatment of migraine in the elderly.
BACKGROUND
Treatment of migraine in the elderly is often difficult and troublesome due to multiple comorbidities, drug interactions, and adverse effects (AEs). SGB may be an effective treatment approach for migraine in the elderly as its clinical use is rarely limited by concomitant diseases and age-related physiological changes; however, no studies have evaluated the effectiveness of SGB in the treatment of migraine in the elderly population.
METHODS
This is a retrospective observational case series study. We retrospectively analyzed patients with migraine aged ≥65 years, who underwent ultrasound-guided SGB for headache management between January 2018 and November 2022. Pain intensity using the numerical rating scale (NRS, 0-10), number of days with headache per month, duration of headache, and the consumptions of acute medications were recorded before SGB treatment, and at 1, 2, and 3 months after the last SGB. Safety assessment included thorough documentation of serious and minor AEs related to SGB.
RESULTS
Of 71 patients, 52 were analyzed in this study. After the final SGB, the NRS scores decreased significantly from a mean (± standard deviation [SD]) of 7.3 (1.2) at baseline to 3.3 (1.4), 3.1 (1.6), and 3.6 (1.6) at 1, 2, and 3 months, respectively (vs. baseline, p < 0.001). The mean (SD) number of headache days per month significantly reduced from 23.1 (5.5) to 10.9 (7.1) (p < 0.001), 12.7 (6.5) (p = 0.001), and 14.0 (6.8) days (p = 0.001) at the 1-, 2-, and 3-month follow-ups, respectively. The values of headache duration were also significantly lower at the 1-month (mean [SD] 12.5 [15.8] h, p = 0.001), 2-month (mean [SD] 11.3 [15.9] h, p = 0.001), and 3-month follow-ups (mean [SD] 14.3 [16.0] h, p = 0.001) compared to pre-treatment baseline (mean [SD] 22.7 [17.1] h). There were 33/52 (64%) patients experiencing at least a 50% reduction in acute medications consumption 3 months after the final SGB treatment. The overall AEs rate associated with ultrasound-guided SGB was 9.0% (26/290 SGBs). There were no serious AEs; all reported AEs were minor and transient.
CONCLUSIONS
Stellate ganglion block treatment could reduce pain intensity, headache frequency, and duration of migraine, thereby reducing the need for adjunctive medications in elderly patients. Ultrasound-guided SGB might be a safe and effective intervention for the treatment of migraine in elderly patients.
Types de publication
Observational Study
Journal Article
Comment
Langues
eng
Sous-ensembles de citation
IM
Pagination
763-770Commentaires et corrections
Type : CommentOn
Informations de copyright
© 2023 American Headache Society.
Références
Haan J, Hollander J, Ferrari MD. Migraine in the elderly: a review. Cephalalgia. 2007;27:97-106.
Sharma TL. Common primary and secondary causes of headache in the elderly. Headache. 2018;58:479-484.
Straube A, Andreou A. Primary headaches during lifespan. J Headache Pain. 2019;20:35.
Riggins N, Ehrlich A. Episodic migraine and older adults. Curr Pain Headache Rep. 2022;26:331-335.
Wijeratne T, Tang HM, Crewther D, Crewther S. Prevalence of migraine in the elderly: a narrated review. Neuroepidemiology. 2019;52:104-110.
Robbins MS, Lipton RB. Management of headache in the elderly. Drugs Aging. 2010;27:377-398.
Hascalovici JR, Robbins MS. Peripheral nerve blocks for the treatment of headache in older adults: a retrospective study. Headache. 2017;57:80-86.
McLean AJ, Le Couteur DG. Aging biology and geriatric clinical pharmacology. Pharmacol Rev. 2004;56:163-184.
Hershey LA, Bednarczyk EM. Treatment of headache in the elderly. Curr Treat Options Neurol. 2013;15:56-62.
Kawabata K, Sago T, Oowatari T, Shiiba S. Prolonged blockade of the cervical sympathetic nerve by stellate ganglion block accelerates therapeutic efficacy in trigeminal neuropathy. J Oral Sci. 2022;64:6-10.
Makharita MY, Amr YM, El-Bayoumy Y. Effect of early stellate ganglion blockade for facial pain from acute herpes zoster and incidence of postherpetic neuralgia. Pain Physician. 2012;15:467-474.
Fan Z, Zheng X, Li D, Chen H, Li L. Comparison of lidocaine and ropivacaine stellate ganglion blockade in treating upper limb postherpetic neuralgia. Medicine (Baltimore). 2022;101:e29394.
Moon S, Lee J, Jeon Y. Bilateral stellate ganglion block for migraine: a case report. Medicine (Baltimore). 2020;99(18):e20023.
Hou J, Pu S, Xu X, Lu Z, Wu J. Real-time ultrasound-guided stellate ganglion block for migraine: an observational study. BMC Anesthesiol. 2022;22:78.
Yoo Y, Lee CS, Kim YC, Moon JY, Finlayson RJ. A randomized comparison between 4, 6 and 8 mL of local anesthetic for ultrasound-guided stellate ganglion block. J Clin Med. 2019;8:1314.
Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38:1-211.
Martins KM, Bordini CA, Bigal ME, Speciali JG. Migraine in the elderly: a comparison with migraine in young adults. Headache. 2006;46:312-316.
Schwedt TJ. Chronic migraine. BMJ. 2014;348:g1416.
Inan LE, Inan N, Karadaş Ö, et al. Greater occipital nerve blockade for the treatment of chronic migraine: a randomized, multicenter, double-blind, and placebo-controlled study. Acta Neurol Scand. 2015;132:270-277.
Chowdhury D, Tomar A, Deorari V, Duggal A, Krishnan A, Koul A. Greater occipital nerve blockade for the preventive treatment of chronic migraine: a randomized double-blind placebo-controlled study. Cephalalgia. 2023;43:3331024221143541.
Huang Y, Xu J, Liu Q, Zeng Z, Zhang Y. Stellate ganglion block successfully relieved medically unexplained chronic pain: a case report. J Int Med Res. 2022;50:3000605221086735.
Zhu G, Kang Z, Chen Y, Zeng J, Su C, Li S. Ultrasound-guided stellate ganglion block alleviates stress responses and promotes recovery of gastrointestinal function in patients. Dig Liver Dis. 2021;53:581-586.
Gupta MM, Bithal PK, Dash HH, Chaturvedi A, Mahajan RP. Effects of stellate ganglion block on cerebral haemodynamics as assessed by transcranial Doppler ultrasonography. Br J Anaesth. 2005;95:669-673.
Uchida K, Tateda T, Hino H. Novel mechanism of action hypothesized for stellate ganglion block related to melatonin. Med Hypotheses. 2002;59:446-449.
Walega DR, Smith C, Epstein JB. Bilateral stellate ganglion blockade for recalcitrant oral pain from burning mouth syndrome: a case report. J Oral Facial Pain Headache. 2014;28:171-175.
Aleanakian R, Chung BY, Feldmann RE Jr, Benrath J. Effectiveness, safety, and predictive potential in ultrasound-guided stellate ganglion blockades for the treatment of sympathetically maintained pain. Pain Pract. 2020;20:626-638.
Shibata Y, Fujiwara Y, Komatsu T. A new approach of ultrasound-guided stellate ganglion block. Anesth Analg. 2007;105:550-551.
Kim H, Song SO, Jung G. A lateral paracarotid approach for ultrasound-guided stellate ganglion block with a linear probe. J Anesth. 2017;31:458-462.