Great occipital nerve blockade for cluster

A 44-year-old man with a past medical history of episodic cluster headache presented in our ED with complaints of multiple daily cluster headache attacks, with cervico-occipital spreading of pain from May to September 2004. The neurological examination showed no abnormalities as well as brain and spine MRI. Great Occipital Nerve (GON) blockade, with Lidocaine 2% (5 ml) and betamethasone (2 mg), were performed in the right occipital region (ipsilaterally to cluster headache), during attack. GON blockade was effective immediately for the attack and the cluster period resolved after the injection. We suppose that the action of GON blockade may involve the trigemino-cervi- cal complex and we moreover strongly suggest to use GON blockade in emergency depart- ments for cluster headache with cervico-occipital spreading as attack abortive therapy, especially in oxygen and sumatrip- tan resistant cluster headache attacks, in patients who com- plaints sumatriptan side-effects or have contraindications to use triptans.