Greater and Lesser Occipital Nerve Blocks for Frequent and Severe Headaches in Children and Adolescents: A Protocolized Repetitive Intervention Study.

INTRODUCTION

Headache management in children and adolescents remains challenging, particularly in patients with high headache-related disability, medication overuse, and comorbid conditions, for whom evidence-based preventive treatment options are limited and often ineffective. This study aimed to evaluate the clinical outcomes and safety of a protocolized, repetitive bilateral greater and lesser occipital nerve block (GONB/LONB) strategy in pediatric patients with frequent and severe headaches.

METHODS

This retrospective study included adolescents aged 11-18 years who underwent bilateral GONB and LONB for headache between 2018 and 2025. At each treatment session, 1 mL of 2% lidocaine was administered at each of four injection sites (bilateral GON and LON), corresponding to a total volume of 4 mL (80 mg) per session. Blocks were administered weekly for 4 weeks, followed by additional applications at 1 and 3 months. Headache severity and disability were evaluated using the visual analog scale (VAS) and the Pediatric Migraine Disability Assessment (PedMIDAS) before and after completion of the block protocol.

RESULTS

Forty-five patients (91.1% female) received a total of 258 bilateral GONB/LONB procedures. The mean number of headache days per month was 20.8 ± 7.9, and the mean headache duration was 11.6 ± 10.7 months. Significant reductions were observed in both VAS and PedMIDAS disability grades following treatment (p < 0.001). At the patient level, 41 of 45 patients (91.1%) met the predefined criteria for clinical response. No serious adverse events occurred.

CONCLUSIONS

Protocolized repetitive bilateral GONB/LONB was well tolerated and was associated with reductions in headache severity and headache-related disability in this predominantly adolescent cohort. However, the uncontrolled retrospective design precludes attribution of these improvements specifically to the intervention. Prospective sham-controlled studies are needed to establish treatment-specific efficacy.