Comparison of the Effectiveness of Greater Occipital Nerve Block and Botulinum Toxin Type A in Chronic Migraine: An Exploratory Pilot Study From a Tertiary Care Centre in a Resource-Limited Setting.

Background Chronic migraine, defined as ≥15 headache days/month with ≥8 migraine days, is a disabling condition with limited effective treatment options. Greater occipital nerve block (GONB) and botulinum toxin type A (BoNTA) are used in chronic migraine management, yet data from certain regions remain scarce. Objective The objective of this study was to demonstrate the safety and efficacy of GONB and BoNTA treatments in patients with chronic migraine. Methods This prospective, observational, non-blinded exploratory pilot study included 20 adult patients with chronic migraine at a tertiary hospital in India (March 2020-October 2021). Patients were offered either GONB or BoNTA via a cafeteria approach. GONB was administered under ultrasound guidance using lidocaine and methylprednisolone, while BoNTA was injected following the PREEMPT (Phase III REsearch Evaluating Migraine Prophylaxis Therapy) protocol. Headache diaries tracked frequency, severity (via visual analogue scale (VAS)), and medication use for four weeks post intervention. Results Sixteen patients (80%) chose GONB, while four (20%) opted for BoNTA. Mean baseline headache days were 22.63 ± 5.1 (GONB) and 26 ± 4.0 (BoNTA). At four weeks, headache days decreased to 10.81 (GONB) and 12.0 (BoNTA). Mean headache-free days post intervention were 17.19 (GONB) and 15.75 (BoNTA). VAS severity scores improved in both groups, with a marked reduction in high-intensity headache days. No serious adverse events occurred; minor local site pain and transient fatigue were the only reported side effects. Conclusion Both GONB and BoNTA significantly reduced headache frequency and severity in chronic migraine patients with favorable short-term safety profiles. GONB, being more accessible and cost-effective, may offer a viable alternative in resource-limited settings. Both GONB and BoNTA are effective and safe in chronic migraine, with GONB offering a cost-effective, practical option for resource-limited settings.