Study objective

Primary headache disorders are prevalent and account for 2% of all emergency department visits. Current treatment options are effective; however, time to pain relief is suboptimal. Alternatives such as peripheral nerve blocks have shown promising results. The objective of this systematic review is to examine the effectiveness of peripheral nerve blocks for timely pain relief.

Methods

We searched Ovid MEDLINE, EMBASE, Web of Science Core Collection, and the Cochrane Central Register of Controlled Trials and included randomized controlled trials comparing peripheral nerve blocks to placebo or active therapy. The primary outcome was pain within 120 minutes. Secondary outcomes were pain after 120 minutes, adverse events, need for rescue medications, and relapse of headache. Two reviewers screened and extracted data independently; mean differences (MDs) were calculated, and results were pooled using a random-effects model.

Results

Eleven studies met our eligibility criteria (n=860), of which 9 were included in the meta-analysis. Pain scores were significantly lower in patients treated with peripheral nerve blocks than with placebo at 15 minutes (MD: −1.17; 95% confidence interval: −1.82 to −0.51) and 30 minutes (MD: −0.99; 95% confidence interval: −1.66 to −0.32), and no serious adverse events were reported. Pain scores for peripheral nerve blocks versus active therapy and secondary outcomes were not pooled due to clinical heterogeneity.

Conclusion

Our review shows peripheral nerve blocks are effective as a rapid treatment option when compared to placebo; however, we were unable to assess effectiveness against standard treatment. Emergency physicians should consider peripheral nerve blocks as an adjunct therapy for patients with primary headache disorders.

中文翻译：

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外周神经阻滞治疗原发性头痛疾病的有效性：系统评价和荟萃分析

学习目标

原发性头痛疾病很普遍，占所有急诊科就诊的 2%。目前的治疗方案是有效的；然而，缓解疼痛的时间并不理想。周围神经阻滞等替代方法已显示出可喜的结果。本系统评价的目的是检查周围神经阻滞对及时缓解疼痛的有效性。

方法

我们检索了 Ovid MEDLINE、EMBASE、Web of Science 核心合集和 Cochrane 中央对照试验注册库，并纳入了比较周围神经阻滞与安慰剂或积极治疗的随机对照试验。主要结果是 120 分钟内的疼痛。次要结局是 120 分钟后的疼痛、不良事件、需要急救药物和头痛复发。两名审稿人独立筛选和提取数据；计算平均差 (MDs)，并使用随机效应模型汇总结果。

结果

11 项研究符合我们的资格标准（n=860），其中 9 项被纳入荟萃分析。在 15 分钟（MD：-1.17；95% 置信区间：-1.82 至 -0.51）和 30 分钟（MD：-0.99；95% 置信区间：- 1.66 至 -0.32），没有报告严重的不良事件。由于临床异质性，未汇总周围神经阻滞与积极治疗和次要结局的疼痛评分。

结论

我们的审查表明，与安慰剂相比，周围神经阻滞作为一种快速治疗选择是有效的；然而，我们无法评估标准治疗的有效性。急诊医师应考虑将周围神经阻滞作为原发性头痛患者的辅助治疗。