الفهرس 
MIGRAINEOnly 14 pages are availabe for public view
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Abstract
Background: Migraine is a common primary headache disorder, which was the second largest contributors of disability-adjusted life-years in the Global Burden of Disease Study. However, different treatment modalities have emerged for migraine including ultrasound guided sphenopalatine ganglion block and greater occipital nerve block, but there weren’t enough studies that compared their efficacy to each other, despite showing efficacy against medical treatment in different types of headaches.
Aim of the study: To compare the efficacy of sphenopalatine ganglion block versus greater occipital nerve block in chronic resistant migraine patients, and 2ry aim is to assess brain MRI imaging and clinical predictors for migraine treatment prognosis.
Method: This study was a two-arm interventional randomized controlled trial, included 40 patients, 20 in each arm (sphenopalatine ganglion block arm and greater occipital nerve block arm), randomized by simple randomization, all patients were assessed initially by headache diary, HIT-6 and MIDAS scales and had MRI brain done. The patients underwent nerve block ultrasound guided, then followed up after one month by headache diary and HIT- 6 scale and three months by MIDAS. Also, the MRI was used to assess the thickness of the anterior cingulate, somatosensory, left middle frontal and inferior temporal cortices.
Results: The two groups were matched as regards the gender, age, type of migraine, frequency and years lived with headache. The study revealed that GON and SPG block, are statistically equally effective (p-value < 0.05) as regards reducing the headache diary parameters, as well as the total pain index and the functional impact by improving the scores on HIT-6 and MIDAS scale. Moreover, the gender showed significant relation to response; males showed poor response, and radiologically the ACC thickness was directly related to response; the thicker the better the response.
Conclusion: Our study indicated that ultrasound guided GON and SPG nerve block are effective treatment modalities for chronic resistant migraine, yet none is superior to the other, and that gender and ACC thickness could contribute to the response to treatment.