Combination effect of ultrasound-guided superior cervical ganglion block and standard triptan for migraine attacks

Background: To examine whether the combination of ultrasound (US)-guided superior cervical ganglion (SCG) block with standard triptans has a superior relief of headache as compared to triptans alone for acute migraine. Methods: The retrospective-prospective cohort study enrolled patients presenting with acute migraine. The records of 243 cases receiving standard triptans and an adjunctive US-guided SCG were reviewed, while 230 cases were prospectively enrolled to receive triptan alone for control after age and sex matching in a 1:1.2 ratio. The primary endpoint was sustained headache relief and complete freedom from pain within post-procedural 24 hours. Secondary outcomes included headache relief and freedom from pain at 2 hours, monthly migraine days (MMDs), migraine disability assessment (MIDAS) scores, migraine-specific quality of life questionnaire (MSQ) scores, need for rescue analgesics use and adverse events. Results: Sustained headache relief was observed in 69.5% of cases in the SCG cohort, yielding a superior outcome increased by 21.7% (95% confidence interval (CI): 13.1%, 30.4%) (p < 0.001). Overall, SCG block plus triptans had a better effect on headache relief and freedom from pain at post-procedural 2 hours, and sustained freedom from headache within 24 hours compared to triptans alone. At 1-month visit, SCG cohort also showed a greater improvement in MMDs (p < 0.01), MIDAS scores (p = 0.040) and MSQ scores (p = 0.036). No major adverse events were observed. Conclusions: There was a superior therapeutic effectiveness of US-guided SCG block in conjunction with standard triptans for better headache relief up to post-procedural 1 month in acute migraine. It had an adjunctive beneficial effect in functional ability, life quality and possible facilitation of avoiding more adverse events.