Anesth Pain Med.  2022 Jan;17(1):62-66. 10.17085/apm.21082.

Greater occipital nerve blockade using ultrasound guidance for the headache of spontaneous intracranial hypotension - A case report -

• Hong JH
• Lee HW
• Lee YH

• KMID: 2526529
• DOI: http://doi.org/10.17085/apm.21082

Abstract

Background
Spontaneous intracranial hypotension occurs due to cerebrospinal fluid leakage from the spinal column, and orthostatic headache is the most common clinical presentation. Recent studies showed that bilateral greater occipital nerve blockade demonstrated clinical efficacy in relieving post-dural puncture headache after caesarean section. Case A 40-year-old male who presented severe orthostatic headache was consulted to our pain clinic from neurology department. He initially felt a dull nature pain over the whole occipital area which then spread over the frontal and parietal areas. His headache was combined with nausea and vomiting. An epidural blood patch was delayed until final cisternography, and bilateral greater occipital nerve blockade using ultrasound guidance was performed instead. After the blockade, the previously existing headache around the occipital and parietal areas disappeared completely, but mild headache persisted around the frontal area.
Conclusions
Greater occipital nerve blockade could be a good therapeutic alternative to improve headache resulting from spontaneous intracranial hypotension.

Keyword

Greater occipital nerve; Orthostatic headache; Spontaneous intracranial hypotension; Ultrasound

Figure

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  Fig. 1. Photography showing the proper position of the linear probe for greater occipital nerve blockade (A). Ultrasound image showing the obliquus capitis inferior (OCI), and the semispinalis capitis (SSC) muscle. Asterisk (*) indicates intermuscular fatty layer between the OCI and the SSC muscle, which is the final target site (B). Red arrow indicates an accumulation of local anesthetics in the intermuscular fatty layer between the OCI and the SSC muscle (C).

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