The particular time interval between injections in these cases should be tailored to the individual patient’s response pattern. The medication used for injection can also be a factor in choice of treatment intervals. Bupivacaine can potentially cause myotoxicity at the site of injection, and some injectors will limit its use accordingly, although its incidence is not well established.[9] Corticosteroid injection may R788 in vivo be associated with both local and systemic AEs,

such as alopecia, cutaneous atrophy, hyperpigmentation, and Cushing’s syndrome, especially with frequent injections at high doses of the drug.[10, 11] Therefore, more caution is warranted in these cases, and injections may need to be performed less frequently to minimize systemic or local AEs. Reports have suggested that corticosteroids may be beneficial in certain headache diagnoses including CH, headache related to sexual activity, cervicogenic headaches, episodic migraine with and without aura, hemiplegic migraine with prolonged aura, chronic migraine, hemicrania continua, and post-traumatic headache.[4, 7, 8, 12-18] Corticosteroids may be beneficial in GON blocks in reducing dynamic mechanical allodynia in migraine patients.[12]

Triamcinolone, methylprednisolone, dexamethasone, betamethasone (dipropionate long-acting salt and disodium phosphate rapid-acting salt), and cortivazol are the most commonly reported corticosteroids used in the management of patient with headache disorders.[4, 7, 8, buy Z-VAD-FMK 12, 14, 16, 17] Clinically, corticosteroids used in GON blockade for the management of headache disorders are usually used in combination

with a local anesthetic. However, treatment of migraine with GON blocks using only corticosteroids has been reported.[19] Table 3 lists the commonly used corticosteroids as well as their half-life and equivalence to triamcinolone. Although the dose range of corticosteroids in GON blocks varies, with dosages as high as 160 mg of methylprednisolone reported, triamcinolone 40-60 mg, or an equivalent dose of a different steroid, in combination with a local anesthetic, may be adequate for headache disorders.[12, 14, 16, 19-21] Study results for the use of corticosteroids in GON blocks have been mixed. This may N-acetylglucosamine-1-phosphate transferase be due to the different doses and steroid types used in the different studies, as well as the variability in headache disorders evaluated. In a controlled study of patients with transformed migraine, GON block using the combination of triamcinolone and local anesthetics was not significantly more effective than injecting local anesthetic alone.[20] In a randomized controlled study of CH patients, however, the suboccipital injection of betamethasone and lidocaine was significantly more effective than saline and lidocaine in inducing headache remission.