{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T01:47:36Z","timestamp":1792806456775,"version":"4.5.0"},"reference-count":15,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2020,9,27]],"date-time":"2020-09-27T00:00:00Z","timestamp":1601164800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["UL1TR001073"],"award-info":[{"award-number":["UL1TR001073"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["headachejournal.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Headache"],"published-print":{"date-parts":[[2020,11]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Greater occipital nerve blocks (GONB) are used increasingly to treat acute migraine.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>We conducted a randomized controlled trial to determine whether GONB was as effective as intravenous metoclopramide for migraine.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a double\u2010dummy, double\u2010blind, parallel\u2010arm, non\u2010inferiority study conducted in 2 emergency departments (EDs). Patients with migraine of moderate or severe intensity were randomized to receive bilateral GONB with each side administered 3\u00a0mL of bupivacaine 0.5% or metoclopramide 10\u00a0mg IV, the putative standard of care. The primary outcome was improvement in pain on a 0\u201010 scale between time 0 and 1\u00a0hour later. To reject the null hypothesis that metoclopramide would be more efficacious in relieving pain, we required that the lower limit of the 95% CI for the difference in pain improvement between those randomized to GONB vs those randomized to metoclopramide be &gt;\u22121.3, a validated minimum clinically important difference. Secondary outcomes included sustained headache relief, defined as achieving and maintaining for 48\u00a0hours a headache level of mild or none without the use of additional analgesic medication, and the use of rescue medication in the ED.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Over a 2.5\u2010year study period, 1358 patients were screened for participation and 99 were randomized, 51 to GONB and 48 to metoclopramide. All of these patients were included in the primary analysis. Patients who received the GONB reported mean improvement of 5.0 (95% CI: 4.1, 5.8) while those who received metoclopramide reported a larger mean improvement of 6.1 (95% CI: 5.2, 6.9). The 95% CI for the between group difference of \u22121.1 was \u22122.3, 0.1. Sustained headache relief was reported by 11\/51 (22%) GONB and 18\/47 (38%) metoclopramide patients (95% CI for rounded difference of 17%: \u22121, 35%). Of the 51 GONB patients, 17 (33%) required rescue medication in the ED vs 8\/48 (17%) metoclopramide patients (95% CI for rounded difference of 17%: 0, 33%). An adverse event was reported by 16\/51 (31%) GONB patients and 18\/48 (38%) metoclopramide patients (95% CI for (rounded) difference of 6%: \u221213, 25%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>GONB with bupivacaine was not as efficacious as IV metoclopramide for the first\u2010line treatment of migraine in the ED.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/head.13961","type":"journal-article","created":{"date-parts":[[2020,9,27]],"date-time":"2020-09-27T08:38:00Z","timestamp":1601195880000},"page":"2380-2388","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":34,"title":["A Randomized, Double\u2010Dummy, Emergency Department\u2010Based Study of Greater Occipital Nerve Block With Bupivacaine vs Intravenous Metoclopramide for Treatment of Migraine"],"prefix":"10.1111","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2753-5860","authenticated-orcid":false,"given":"Benjamin W.","family":"Friedman","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine Albert Einstein College of Medicine Montefiore Bronx NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eddie","family":"Irizarry","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Albert Einstein College of Medicine Montefiore Bronx NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Williams","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Albert Einstein College of Medicine Montefiore Bronx NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clemencia","family":"Solorzano","sequence":"additional","affiliation":[{"name":"Pharmacy Department Montefiore Bronx NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleftheria","family":"Zias","sequence":"additional","affiliation":[{"name":"Pharmacy Department Montefiore Bronx NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5426-5333","authenticated-orcid":false,"given":"Matthew S.","family":"Robbins","sequence":"additional","affiliation":[{"name":"Department of Neurology Weill Cornell Medicine New York\u2010Presbyterian New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa A.","family":"Harrilal","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Albert Einstein College of Medicine Montefiore Bronx NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Del Valle","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Albert Einstein College of Medicine Montefiore Bronx NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Polly E.","family":"Bijur","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Albert Einstein College of Medicine Montefiore Bronx NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E. John","family":"Gallagher","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Albert Einstein College of Medicine Montefiore Bronx NY USA"},{"name":"Department of Neurology Albert Einstein College of Medicine Montefiore Bronx NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,9,27]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/0333102414539055"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1553-2712.2009.00587.x"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2018.03.054"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/ane.12952"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/head.12053"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/head.12835"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1177\/0333102413485658"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/0333102411417901"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1553-2712.1996.tb03402.x"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/head.13395"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clineuro.2017.12.026"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000006059"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2017.08.027"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/WCO.0b013e3283378d5c"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1526-4610.2010.01676.x"}],"container-title":["Headache: The Journal of Head and Face Pain"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/head.13961","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/head.13961","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/headachejournal.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/head.13961","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,2]],"date-time":"2025-11-02T12:35:42Z","timestamp":1762086942000},"score":1,"resource":{"primary":{"URL":"https:\/\/headachejournal.onlinelibrary.wiley.com\/doi\/10.1111\/head.13961"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,9,27]]},"references-count":15,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2020,11]]}},"alternative-id":["10.1111\/head.13961"],"URL":"https:\/\/doi.org\/10.1111\/head.13961","archive":["Portico"],"relation":{},"ISSN":["0017-8748","1526-4610"],"issn-type":[{"value":"0017-8748","type":"print"},{"value":"1526-4610","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,9,27]]},"assertion":[{"value":"2020-05-20","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-08-06","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-09-27","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}