A Cautionary Tale: Unveiling Suboccipital Muscle Atrophy Following Occipital Nerve Blocks for Chronic Cluster Headaches - Two Case Reports | [Journal of Pioneering Medical Sciences • 2025]

Author(s):

1. Hassan A. Moria: Anesthesia and Critical Care, Department of Surgery, Faculty of Medicine, University of Tabuk, Tabuk, Saudi Arabia

2. Amirah M. Alatawi: Department of Community and Family Medicine, Faculty of Medicine, University of Tabuk, Tabuk, Saudi Arabia

Abstract:

Occipital Nerve Blocks (ONBs) are a common treatment for chronic cluster headaches; however, data on their long-term complications remain limited. This case report highlights a rare complication of suboccipital muscle atrophy after repeated ONBs in patients with chronic cluster headaches. Both patients, unresponsive to multiple pharmacological treatments, exhibited typical cluster headache symptoms such as severe periorbital pain, lacrimation and rhinorrhea, while brain and cervical spine imaging appeared normal. Each received ONBs with bupivacaine and triamcinolone, resulting in temporary relief for several months. However, after a second ONB cycle, both patients developed suboccipital muscle atrophy, which was confirmed by ultrasound. These cases suggest a potential link between repeated ONBs and suboccipital muscle atrophy, emphasizing the need for clinicians to be mindful of this rare complication. Alternative interventional strategies or preventive measures may be warranted in managing chronic cluster headaches to mitigate this risk.

Page(s): 81-85

DOI: 10.47310/jpms2025140612

Published: Journal: Journal of Pioneering Medical Sciences, Volume: 14, Issue: 6, Year: 2025

Keywords:

Case report , Occipital Nerve Block , Chronic Cluster Headache , Suboccipital Muscle Atrophy

References:

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[4] Mutagi . .Full-thickness local soft tissue atrophy following steroid injection to greater occipital nerve. ” Pain practice: the official journal of World Institute of Pain, 11(2011) : 582-583.

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