ArticlePain and therapy2026
Ultrasound-Guided Greater Occipital Nerve Block Across Headache Phenotypes: Outcomes and Determinants of Response in a Prospective Cohort.
Article in Pain and therapy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionGreater occipital nerve blocks (GONBs) are used across headache phenotypes, but short-term effectiveness and predictors of response in mixed real-world cohorts remain uncertain.
methodsWe conducted a prospective observational study of adults with chronic headache phenotypes receiving a single ultrasound-guided proximal (C2) GONB. Primary outcomes were T0 → T1 (1-month) changes in pain (NRS), headache impact (HIT-6), sleep (PSQI), and monthly attacks (crises) using paired Wilcoxon tests. We defined HIT-6 responders as ≥ 10-point reduction. Predictors of response were evaluated with multivariable logistic regression; continuous reductions were modeled with multivariable linear regression.
resultsTwenty-nine patients were included (chronic migraine n = 10; cluster n = 5; occipital neuralgia n = 7; cervicogenic n = 7; 69% female; mean age 58.2 ± 13.7 years). At 1 month, all outcomes had improved significantly: HIT-6 median 66 → 52 (Δ - 12; 95% CI - 15 to - 8; p < 0.001), PSQI 12 → 8 (Δ - 3.5; p < 0.001), monthly (crises) 24 → 12 (Δ - 14.0; 95% CI - 20.0 to - 10.0; p < 0.001), and NRS 8 → 4 (Δ - 3; p < 0.001). In the logistic model, higher baseline pain independently predicted HIT-6 response (OR 3.38, 95% CI 1.22-13.47; p = 0.017), whereas symptom duration was not associated. In multivariable linear models, cluster headache was associated with greater improvements (ΔNRS, ΔHIT-6, Δcrises), while a rheumatic comorbidity predicted smaller improvements across outcomes.
conclusionAcross chronic headache phenotypes, a single ultrasound-guided proximal (C2) GONB was associated with clinically meaningful 1-month improvements in pain, impact, sleep, and attack frequency. Response, however, was not uniform: higher baseline pain intensity and the cluster phenotype identified the patients most likely to benefit, whereas a rheumatic comorbidity marked probable non-responders. These predictors offer a practical basis for patient selection and should be confirmed prospectively.
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