Locally injected steroids may not do much good for chronic headache pain

Locally injected steroids apparently don't enhance treatments for acute headache or migraine pain.

A study by neurologists at the Jefferson Headache Center at Thomas Jefferson University Hospital in Philadelphia did not show any benefit to adding steroids to local anesthetics to treat daily headaches.

According to Avi Ashkenazi, M.D., assistant professor of neurology at Jefferson Medical College of Thomas Jefferson University, greater occipital nerve block (GONB) is a technique to treat acute headaches by locally injecting anesthetics such as lidocaine just under the skin to provide acute pain relief for acute headache attacks and migraines. Such treatments can work quickly, perhaps in seconds or by five to 10 minutes, and its effectiveness could last from hours to two or three days to several weeks. Treatment can be repeated if needed, he notes, and it has few side effects.

There are two ways to block the occipital nerves: by injecting a local anesthetic alone or by adding an anti-inflammatory steroid along with the anesthetic. No data exist whether one is better than the other, but the use of corticosteroids is controversial because of their potential side effects, such as hair loss at the site of injection. He notes that there is no consensus among headache experts about steroid use for headache.

Dr. Ashkenazi and his co-workers at the Jefferson Headache Center studied 29 men and women with chronic daily headaches who came to the center. Patients were divided into two groups – those who were given GONB treatment with lidocaine and bupivicaine alone and those who were given the two drugs with steroids. The patients in the trial didn't know which treatment they received. Each was asked to assess the severity of their headache and related symptoms such as nausea, vomiting, light sensitivity and sound sensitivity before treatment and 20 minutes after treatment. Patients were also given a diary for four weeks to document their level of daily symptoms and headaches.

The results showed that both treatments after 20 minutes were equally effective in treating headache. “We found no significant differences and no evidence of additional benefit from having a steroid,” says Dr. Ashkenazi. He presented his team's findings last week at the 2006 annual meeting of the American Academy of Neurology in San Diego.

Dr. Ashkenazi and his team are looking at the next four weeks of post-therapy data and are continuing to recruit more patients. He notes that they might eventually find that steroids lengthen the anti-inflammatory effect of the injection.