Efficacy and safety of greater occipital nerve and supraorbital nerve blocks in patients with migraine: Meta-analysis

Context: Migraines, which affect over 10% of the global population and cause disability, prompt the review of the greater occipital nerve (GON) and supraorbital nerve (SON) blocks to minimize systemic effects. Aims: To compare GON, GON+SON block, and SON block in migraine management. Methods: Articles from 2014 to 2022, adhering to PRISMA 2020 guidelines, underwent selection based on inclusion and exclusion criteria. Cochrane RoB 2.0 assessed article quality, Review Manager ver. 5.4.1 was used for statistical analysis. Results: The meta-analysis of 13 randomized controlled trials revealed that the GON block effect on VAS score versus the control group showed a pooled MD of -0.98 (95% CI = -2.31 to 0.36, p = 0.15). GON+SON injection had a pooled effect of -3.7 (95% CI = -0.21 to 2.08, p = 0.04) compared to the control, while SON block resulted in lower VAS scores (3.08 +/- 0.3 vs. 6.71 +/- 0.3). Pooled mean differences for migraine attack frequency, cumulative duration, and acute medication use were -1.82 (95% CI = -3.15 to -0.5, p = 0.007), -0.25 (95% CI = -2.84 to 2.34, p = 0.85), and -1.1 (95% CI = -2.04 to 0.16, p = 0.02), respectively. The pooled odds ratio for a 50% pain reduction was 1.62 (95% CI = 0.71 to 3.68, p = 0.25). Subgroup analysis indicated that VAS score with local anesthesia had a pooled MD of -1.68 (95% CI = -3.46 to 0.11, p = 0.07). After GON injection with 15 mg bupivacaine and 10 mg lidocaine, the VAS score significantly decreased, with mean differences of -2.2 (95% CI = -4.13 to -0.27, p = 0.03) and -4.5 (95% CI = -4.66 to -4.34, p<0.00001), respectively. Conclusions: GON and SON blocks demonstrate more effectiveness compared to GON blocks.