Greater Occipital Nerve Block With Bupivacaine for Acute Migraine

A Randomized, Sham-controlled Trial of Greater Occipital Nerve Block as Second Line Therapy for ED Patients With Acute Migraine

This is a randomized, sham-controlled study of greater occipital nerve block (GONB) using bupivacaine 0.5% for emergency department patients with acute migraine. Patients are only enrolled if they fail first line therapy with metoclopramide.

The investigators are testing the following hypothesis:

In a population of patients who present to an ED with acute migraine and have been treated with parenteral metoclopramide unsuccessfully, bilateral greater occipital nerve blocks with bupivicaine will provide greater rates of short-term and sustained headache freedom than bupivacaine injected intradermally.

Inclusion Criteria:

• ED patient with acute migraine or probable migraine
• Fail first line therapy with metoclopramide

Exclusion Criteria:

• Can't obtain consent
• Concern for secondary headache
• Skull defect
• Propensity for bleeding
• Overlying infection
• Pregnancy
• Allergy, intolerance study medication