Peripheral Nerve Block and Topiramate in the Treatment of Medication Overuse Headaches

Comparison of Effects of Peripheral Nerve Block and Topiramate in the Treatment of Medication Overuse Headaches: A Randomised Parallel Group Study

Purpose: In this study, the investigators compared the effectiveness of peripheral nerve block (greater occipital nerve block with supratrochlear nerve block) versus topiramate as detoxification therapies in chronic migraine patients with medication overuse headache.

Methods: At least ninety chronic migraine patients with medication overuse headache are aimed to include in this study. Patients will be divided into the two groups. The first group will receive topiramate (n=45, estimated) and the second group will receive nerve block (n=45, estimated) as detoxification therapy. Patients' records regarding the visual analog scale (VAS) scores and headache frequencies are aimed to be collected before and after the therapy. Comparisons regarding VAS scores, headache frequencies, 50% responder rates and 75% responder rates will be performed in between topiramate and nerve block groups.

Inclusion Criteria:

1. Chronic migraine diagnosis according to International Classification of Headache-2 Disorders (ICHD)
2. w/o pregnancy or breastfeeding.
3. w/o acute or chronic psychiatric disorders.
4. w/o nephrolithiasis.
5. w/o medication of anticoagulant and antiaggregant.
6. w/o allergy to topiramate or bupivacaine.
7. w/o prophylaxis within the last three months with any of; propranolol, nebivolol, topiramate, valproate, venlafaxine, duloxetine, amitriptyline, flunarizine.
8. w/o previous history of peripheral nerve block, botulinum toxin or acupuncture.
9. w/o history of multiple sclerosis, movement disorders, epilepsy, stroke, and tumor.

J-w/o chronic systemic diseases including hypertension, cardiac insufficiency, diabetes, pulmonary disease, kidney disease, liver disease, and peripheral arterial disease.

Exclusion Criteria:

1. Lost to follow up within the pretreatment period during the detoxification therapy after the detoxification therapy
2. could not tolerate the peripheral nerve block or topiramate