Greater Occipital Nerve Block With Bupivacaine for Acute Migraine

A Randomized, Sham-controlled Trial of Greater Occipital Nerve Block as Second Line Therapy for ED Patients With Acute Migraine

This is a randomized, sham-controlled study of greater occipital nerve block (GONB) using bupivacaine 0.5% for emergency department patients with acute migraine. Patients are only enrolled if they fail first line therapy with metoclopramide.

The investigators are testing the following hypothesis: In a population of patients who present to an ED with acute migraine and have been treated with parenteral metoclopramide unsuccessfully, bilateral greater occipital nerve blocks with bupivicaine will provide greater rates of short-term and sustained headache freedom than bupivacaine injected intradermally.

Bilateral intradermal injection of 0.5cc of 0.5% bupivacaine, delivered superficially to the area overlying the greater occipital nerve

Pain assessed using a standard ordinal headache intensity scale, in which subjects describe their headache as "severe", "moderate", "mild", or "none". Those with headache level = none, experience freedom from headache.

Attaining a headache level of "mild" or "none" within one hour of procedure and maintaining this for 48 hours without use of additional medication

Participants will be asked the following question: Do you want to receive the same procedure the next time you come to the ER with migraine?

The numerical scale, 0-10 pain scores will be obtained with 0 being "no pain" and 10 being "the worst pain imaginable."

Inclusion Criteria: ED patient with acute migraine or probable migraine Fail first line therapy with metoclopramide Exclusion Criteria: Can't obtain consent Concern for secondary headache Skull defect Propensity for bleeding Overlying infection Pregnancy Allergy, intolerance study medication