Therapeutic effectiveness and safety profile of steroid-based greater occipital nerve blocks in cluster headaches: a systematic review and meta-analysis
Authors' conclusion
Particulate steroid-based GONBs show promise for CH treatment by decreasing attack frequency, while mostly producing short-term adverse events.
Study context
- Population
- Patients with cluster headaches (episodic and chronic)19 studies
- Comparison
- Steroid-based greater occipital nerve blocks (GONBs) vs control
- Outcome
- Probability of response (proportional meta-analysis of GONB arms)
Methodological detailsrandom-effects, proportional and binary meta-analyses, subgroup and risk of bias (RoB) sensitivity analyses, GRADE, RoB assessed with Cochrane RoB 2.0 and ROBINS-I
- Random-effects
- Proportional and binary meta-analyses
- Subgroup and RoB sensitivity analyses
- GRADE
- RoB assessed with Cochrane RoB 2.0 and ROBINS-I
Pooled result
As reported in the abstract
Response, CH
73%
Response, ECH
77%
Response, CCH
69%
Further pooled results
Mean duration of effect
Days
- CH
- 43
- ECH
- 61.6
- CCH
- 32.2
Attack frequency, GONBs vs control (binary meta-analysis of randomised studies)
- CH: non-significant reduction
- P = 0.06
- ECH: non-significant reduction
- P = 0.11
- CCH: significant reduction, relative risk
- 2.67 (95% CI 1.24 to 5.75; p=0.01)
Probability of response (RoB sensitivity analysis)
- CH
- 79%
- ECH
- 75%
- CCH
- 70%
Safety
| Outcome | P value |
|---|---|
| Adverse eventsDid not differ | P = 0.43 |
Adverse events
- Mostly minor, transient adverse events
Original publication
Therapeutic effectiveness and safety profile of steroid-based greater occipital nerve blocks in cluster headaches: a systematic review and meta-analysis. Reg Anesth Pain Med. Published 31 December 2025. doi:10.
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