Efficacy of Ultrasound-Guided Combined Greater Occipital Nerve Block and Greater Auricular Nerve Block Versus Greater Occipital Nerve Block Alone in the Management of Chronic Migraine

Migraine is one of the most prevalent neurological disorders worldwide and remains aleading cause of disability, particularly among individuals of working age. Chronicmigraine affects approximately 1‐2% of the global population and is associated withsubstantial impairment in quality of life, reduced work productivity, and increasedhealthcare utilization . Despite recent advances in migraine management, includingcalcitonin gene‐related peptide (CGRP)‐targeted monoclonal antibodies and gepants, manypatients continue to experience inadequate symptom control, treatment intolerance, orlimited access to these therapies . Consequently, peripheral nerve blocks have emerged aseffective non‐pharmacological treatment options for patients with refractory migraine andother primary headache disorders .Among the available interventional techniques, the greater occipital nerve block (GONB)is one of the most widely used procedures for both acute and preventive treatment ofmigraine. The therapeutic effect of GONB is believed to result from modulation ofnociceptive transmission within the trigeminocervical complex, thereby reducing centralsensitization and interrupting convergence between cervical and trigeminal afferents.Several randomized clinical trials and systematic reviews have demonstrated that GONBsignificantly reduces headache intensity, headache frequency, analgesic consumption, andmigraine‐related disability while maintaining an excellent safety profile .Migraine pain often involves overlapping sensory territories supplied by interconnectedperipheral nerves. The greater auricular nerve (GAN), a superficial sensory branch of thecervical plexus arising from the C2 and C3 spinal nerves, supplies the skin over theparotid region, mastoid process, lower auricle, and angle of the mandible . Becausecervical sensory afferents converge with trigeminal nociceptive pathways within thetrigeminocervical complex, the GAN may contribute to peripheral nociceptive transmissioninvolved in migraine pathophysiology . Combined blockade of multiple cervical sensorynerves may therefore provide broader interruption of peripheral nociceptive input,potentially enhancing analgesic efficacy and reducing central sensitization .Ultrasound‐guided GONB has been shown to produce greater procedural accuracy andconsistent clinical outcomes than landmark‐guided techniques .Despite the increasing use of peripheral nerve blocks in headache medicine, evidenceregarding the additional benefit of combining a greater auricular nerve block with thestandard greater occipital nerve block remains limited. To the best of our knowledge, noprospective randomized double‐blind clinical trial has directly comparedultrasound‐guided combined GONB and GAN block with GONB alone in patients with chronicmigraine.