A comparison of the clinical efficacy of GON block at the C2 level and GON block at the classical distal occipital level in the treatment of cluster headache

Background: This study aimed to compare the clinical efficacy of C2-level and distal greater occipital nerve (GON) blockade in the management of cluster headache (CH), focusing on pain relief onset and overall treatment outcomes. Methods: In this retrospective study, 48 patients diagnosed with CH were divided into two equal groups: one receiving bilateral C2 GON blocks and the other undergoing bilateral distal GON blocks. Both groups were treated with dexamethasone as the steroid and bupivacaine as the local anaesthetic. Pain relief and treatment duration were assessed, and adverse events were monitored. Results: Both GON blockade techniques were effective in reducing CH symptoms. Patients treated with C2 GON blocks achieved complete pain relief by the third week, allowing for treatment cessation. In contrast, the distal GON block group required up to six injections for similar levels of relief. Rapid pain control was more pronounced in the C2 GON group, with no significant adverse effects observed in either group. Conclusions: C2 GON blockade demonstrated greater efficacy for early pain relief in CH patients compared with distal GON blockade. These findings suggest that C2 GON blockade may be a more suitable option for both transitional and preventive therapy in CH. Further studies are recommended to confirm these results and to explore the long-term benefits of C2 GON blockade in CH management.

C2 GON block; GON block; Cluster headache; Greater occipital nerve; Distal GON block

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