SynthesisPain practice : the official journal of World Institute of Pain2026
Exploring Proximal and Distal Ultrasound-Guided Greater Occipital Nerve Block Approaches in Migraine: A Systematic Review and Meta-Analysis.
Synthesis in Pain practice : the official journal of World Institute of Pain, 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
objectiveTo evaluate the effectiveness and safety of proximal and distal ultrasound-guided greater occipital nerve block (US-GONB) in patients with migraine.
methodsPubMed, Scopus, Web of Science, and the Cochrane Library were searched up to July 2025. Studies assessing US-GONB in migraine were included. Data were pooled using a random-effects model and expressed as mean difference (MD) with 95% confidence intervals (CI). Subgroup analyses were conducted based on the injection site.
resultsTwelve studies (658 patients) were included. US-GONB significantly reduced pain intensity (MD = -3.48 points, 95% CI [-3.84, -3.11]), monthly headache frequency (MD = -9.12 days, 95% CI [-11.65, -6.58]), headache duration (MD = -18.98 h, 95% CI [-26.86, -11.11]), and monthly analgesic use (MD = -10.01, 95% CI [-12.91, -7.11]). No significant subgroup difference was observed in pain intensity between injection sites. For monthly headache frequency, a significant subgroup difference was observed, with the proximal subgroup demonstrating numerically larger reductions than the distal subgroup (-10.83 vs. -6.36 days; p = 0.006). Adverse events were generally mild and transient: loss of pinprick sensation occurred in 80% of proximal vs. 100% of distal injections, dizziness in 22.7% vs. 3.9%, moderate-to-severe migraine attacks in 20.1% vs. 12.9%, and cerebellar-like symptoms in 12.5% vs. 0%, respectively. Vasovagal syncope (9.1%) and local pain (8.1%) were reported only in proximal injections.
conclusionsUS-GONB appears to be a safe and effective intervention for migraine, significantly improving pain and headache burden. Proximal injections may be associated with greater reductions in headache frequency; however, these findings were based on indirect comparisons. Further comparative trials are warranted to optimize anatomical targeting.
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