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      Adiposis dolorosa of scalp presenting with severe headache: an unusual case

      case-report

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          Abstract

          A 46-year-old female, known case of adiposis dolorosa since adolescence, noticed painful thickening of scalp in bilateral parieto-occipital areas and vertex 1 year back. Six weeks prior to the presentation to our service, she developed severe occipital headache refractory to drug treatment. She improved after bilateral greater occipital nerve blocks. She was subjected to bilateral greater occipital chemical neurolysis which has given her complete pain relief.

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          Greater occipital nerve blockade for cluster headache.

          S Silberstein, Charles Stiles, Ellen Peres … (2002)
          Cluster headache is perhaps the most painful of the primary headache disorders. Its treatment includes acute, transitional, and preventive therapy. Despite the availability of many treatments, cluster headache patients can still be difficult to treat. We treated 14 cluster headache patients with greater occipital nerve block as transitional therapy (treatment initiated at the same time as preventive therapy). The mean number of headache-free days was 13.1 + 23.6. Four patients (28.5%) had a good response, five (35.7%) a moderate, and five (35.7%) no response. The greater occipital nerve block was well tolerated with no adverse events. Headache intensity, frequency and duration were significantly decreased comparing the week before with the week after the nerve block (P < 0.003, P = 0.003, P < 0.005, respectively). Greater occipital nerve blockade is a therapeutic option for the transitional treatment of cluster headache.
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            The clinical anatomy of the cervical dorsal rami.

            N Bogduk (2015)
            A detailed description of the anatomy of the cervical dorsal rami is provided on the basis of the past literature and independent studies on five cadavers. In particular, the anatomy of the upper cervical dorsal rami and the innervation of the cervical zygapophyseal joints are described. The clinical significance of the cervical dorsal rami is discussed in relation to headache, occipital neuralgia, and neck pain. The surgical anatomy of cervical facet denervation is discussed. The radiologic anatomy of the medial branches of the cervical dorsal rami is described, and target points suitable for diagnostic blocks or facet denervation are illustrated.
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              Occipital nerve blocks: when and what to inject?

              Joshua Tobin, Stephen S Flitman (2015)
              Occipital nerve block (ONB) is a promising treatment for headaches. Its indications, selection criteria, and best techniques are not clear, however. To summarize in narrative format what is known about ONBs and what needs to be learned. MD Consult and Google Scholar were searched using the terms occipital, suboccipital, block, and injection to identify relevant articles that were reviewed. This process was repeated for all additional pertinent articles identified from these articles, and so on, until no additional articles were identified. A total of 21 articles were identified. Occipital nerve block is an effective treatment for cervicogenic headache, cluster headache, and occipital neuralgia. While a double blinded randomized placebo controlled clinical trial is lacking, multiple open label studies reported favorable results for migraine. Two other possible uses of ONB worthy of further study are use as a rescue treatment and as an adjunctive treatment for medication overuse headache. ONB may be effective for tension headache, but only under very specific circumstances. ONB is either ineffective or only effective under as yet unstudied circumstances for hemicrania continua and chronic paroxysmal hemicrania. Some practitioners use occipital nerve (ON) tenderness to palpation (TTP) or reproduction of headache pain with ON pressure (RHPONP) as selection criteria for identifying appropriate patients. While only a clinical trial can produce a definitive answer, current evidence suggests that these selection criteria are not necessary for cervicogenic headache or cluster headache. Occipital neuralgia by definition involves TTP of the ONs. Whether RHPONP or ON TTP predicts success in migraine is unclear, and may relate to whether steroids are used. A single blinded randomized controlled trial evaluating local anesthetic with steroids vs local anesthetic alone for transformed migraine reported slightly worse results with steroids, but there are several alternate explanations for this finding other than steroids being counterproductive. The technique of repetitive ONBs deserves further study.
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                Author and article information

                Contributors
                Amit Mahore: +91-22-24129884 , +91-22-24143435 , amit2mahore@yahoo.co.in
                Journal
                Journal ID (nlm-ta): J Headache Pain
                Journal ID (iso-abbrev): J Headache Pain
                Title: The Journal of Headache and Pain
                Publisher: Springer Milan (Milan )
                ISSN (Print): 1129-2369
                ISSN (Electronic): 1129-2377
                Publication date (Electronic): 2 September 2010
                Publication date (Print): December 2010
                Volume: 11
                Issue: 6
                Pages: 539-541
                Affiliations
                [1 ]Department of Medicine, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Parel, Mumbai, India
                [2 ]Department of Neurosurgery, King Edward VII Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Parel, Mumbai, 400012 India
                [3 ]Department of Neuro-anaesthesia, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Parel, Mumbai, India
                Article
                Publisher ID: 253
                DOI: 10.1007/s10194-010-0253-9
                PMC ID: 3476222
                PubMed ID: 20811764
                SO-VID: a4c6b7f0-eea3-48c4-9462-fb97b7a0efc4
                Copyright © © Springer-Verlag 2010
                History
                Date received : 29 May 2010
                Date accepted : 16 August 2010
                Categories
                Subject: Brief Report
                Custom metadata
                issue-copyright-statement © Springer-Verlag 2010

                ScienceOpen disciplines: Anesthesiology & Pain management
                Keywords: greater occipital nerve block,headache,painful lipoma,adiposis dolorosa
                Data availability:
                ScienceOpen disciplines: Anesthesiology & Pain management
                Keywords: greater occipital nerve block, headache, painful lipoma, adiposis dolorosa

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