{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T15:47:01Z","timestamp":1770652021001,"version":"3.49.0"},"reference-count":45,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2025,12,14]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cluster headaches (CHs), including episodic (ECH) and chronic (CCH) forms, are intensely painful and disabling, with limited preventative options. Greater occipital nerve blocks (GONBs) are frequently used in practice; however, the safety and efficacy of steroid-based injections, alone or combined with local anesthetic in CH patients, remain unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the efficacy and safety of corticosteroid-based GONBs, with or without local anesthetic, in patients with CHs, including ECH and CCH. Outcomes included attack frequency, proportion of responders, duration of effect, pain reduction, and adverse events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Evidence review<\/jats:title>\n                    <jats:p>\n                      We systematically searched Cochrane, Embase, Emcare, PubMed, and PsycInfo from inception to March 24, 2025 for eligible studies involving patients with CHs who received GONBs stratified by corticosteroid use. Data were narratively synthesized, with random-effects meta-analyses performed: a proportional meta-analysis of GONB arms, and a binary meta-analysis of randomized studies comparing GONBs versus control (saline\u00b1local anesthetic). Subgroup and risk of bias (RoB) sensitivity analyses were conducted for ECH and CCH. RoB was assessed using the Cochrane RoB 2.0 and ROBINS-I tools. Certainty of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation. Protocol registered on OSF (\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/doi.org\/10.17605\/OSF.IO\/6EAZN\">https:\/\/doi.org\/10.17605\/OSF.IO\/6EAZN<\/jats:ext-link>\n                      ). No funding was received.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>Nineteen studies were included, comprising 758 CHs, 324 ECHs, and 375 CCH patients. All studies suggested improvements in outcomes with particulate steroid-based GONBs. Pooled data showed similar efficacy between single and multiple injections, with mostly minor, transient adverse events and consistent reductions in pain across studies. Mean duration of effect was 43 days (CH), 61.6 days (ECH), and 32.2 days (CCH). Proportional meta-analyses explored probabilities of response: CH=73%, ECH=77%, CCH=69% (I\u00b2=86.5%, 47.8%, 89.9%). Sensitivity analyses provided similar estimates: CH=79%, ECH=75%, CCH=70%. Binary meta-analyses showed non-significant reductions in attack frequency for CH (p=0.06) and ECH (p=0.11), and a significant reduction for CCH (p=0.01, relative risk=2.67, 95% CI 1.24 to 5.75). Adverse events did not differ between groups (p=0.43).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Particulate steroid-based GONBs show promise for CH treatment by decreasing attack frequency, while mostly producing short-term adverse events. The evidence quality spans from very low to moderate.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/rapm-2025-106987","type":"journal-article","created":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T13:50:34Z","timestamp":1767189034000},"page":"rapm-2025-106987","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Therapeutic effectiveness and safety profile of steroid-based greater occipital nerve blocks in cluster headaches: a systematic review and meta-analysis"],"prefix":"10.1136","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-4922-437X","authenticated-orcid":false,"given":"Ashmit Daiyan","family":"Mustafa","sequence":"first","affiliation":[{"name":"Sunshine Hospital, Western Health, Sunshine, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luciana","family":"Freire de Oliveira","sequence":"additional","affiliation":[{"name":"Clinical Surgery Department, Amazon, Manaus, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6709-3908","authenticated-orcid":false,"given":"Raquel","family":"Espinola Saldanha","sequence":"additional","affiliation":[{"name":"Anesthesiology Department, Instituto Jos\u00e9 Frota Hospital, Fortaleza, Cear\u00e1, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fernanda Cravo","family":"Arag\u00e3o","sequence":"additional","affiliation":[{"name":"Universidade Salvador, Salvador, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karan","family":"Varshney","sequence":"additional","affiliation":[{"name":"Monash University, Melbourne, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zheng Yang","family":"Ding","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Pain, Sunshine Hospital, Melbourne, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zamil Mehboob","family":"Karim","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Pain, Sunshine Hospital, Melbourne, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,12,31]]},"reference":[{"key":"2025123105502543000_rapm-2025-106987v1.1","doi-asserted-by":"publisher","DOI":"10.1177\/0333102417738202"},{"key":"2025123105502543000_rapm-2025-106987v1.2","doi-asserted-by":"publisher","DOI":"10.1111\/head.14021"},{"key":"2025123105502543000_rapm-2025-106987v1.3","doi-asserted-by":"publisher","DOI":"10.1111\/head.12866"},{"key":"2025123105502543000_rapm-2025-106987v1.4","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.06314"},{"key":"2025123105502543000_rapm-2025-106987v1.5","doi-asserted-by":"crossref","first-page":"3331024241291597","DOI":"10.1177\/03331024241291597","article-title":"ANODYNE study: A double-blind randomized trial of greater occipital nerve block of methylprednisolone and lignocaine versus placebo as a transitional preventive treatment for episodic cluster headache","volume":"44","author":"Chowdhury","year":"2024","journal-title":"Cephalalgia"},{"key":"2025123105502543000_rapm-2025-106987v1.6","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1136\/jnnp-2023-331066","article-title":"Effectiveness and safety profile of greater occipital nerve blockade in cluster headache: a systematic review","volume":"95","author":"Gordon","year":"2023","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"2025123105502543000_rapm-2025-106987v1.7","doi-asserted-by":"publisher","DOI":"10.1080\/14737175.2020.1809379"},{"key":"2025123105502543000_rapm-2025-106987v1.8","doi-asserted-by":"crossref","unstructured":"Benzon HT , Elmofty D , Shankar H , et al . Use of corticosteroids for adult chronic pain interventions: sympathetic and peripheral nerve blocks, trigger point injections - guidelines from the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, the American Society of Interventional Pain Physicians, and the International Pain and Spine Intervention Society. 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Efficacy and safety of greater occipital nerve block with a small volume of lidocaine and methylprednisolone in tertiary headache center. 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