Original article
Patterns of anaesthetic pericranial nerve block in headache patients
Patrones de bloqueo anestésico de nervios pericraneales en el paciente con cefalea
S. Santos Lasaosaa,
, A. Gago Veigab, Á.L. Guerrero Peralc, J. Viguera Romerod, P. Pozo-Rosiche
Corresponding author
a Servicio de Neurología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
b Servicio de Neurología, Instituto de Investigación Sanitaria, Hospital Universitario La Princesa, Madrid, Spain
c Servicio de Neurología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
d Unidad Gestión Clínica de Neurología, Hospital Virgen Macarena, Sevilla, Spain
e Unidad de Cefalea, Servicio de Neurología, Hospital Universitari Vall d’Hebron, Grupo de Investigación en Cefalea, VHIR, UAB, Barcelona, Spain
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"apellidos" => "Pozo-Rosich" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Servicio de Neurología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Neurología, Instituto de Investigación Sanitaria, Hospital Universitario La Princesa, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Neurología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Unidad Gestión Clínica de Neurología, Hospital Virgen Macarena, Sevilla, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Unidad de Cefalea, Servicio de Neurología, Hospital Universitari Vall d’Hebron, Grupo de Investigación en Cefalea, VHIR, UAB, Barcelona, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Patrones de bloqueo anestésico de nervios pericraneales en el paciente con cefalea" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 954 "Ancho" => 1568 "Tamanyo" => 94317 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Nerve territories treated with ABs (2016).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Anaesthetic block (AB) is increasingly used to treat headache both in Spain and abroad.<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">1–13</span></a> This therapeutic resource may be used alone or in combination with other treatments. Although ABs are common practice in numerous specialised headache units, usage patterns vary greatly between professionals.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The results of a survey on the use of the technique conducted by the Spanish Society of Neurology's (SEN) Headache Study Group (GECSEN) were disclosed at the SEN's Annual Meeting in 2012.<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">14</span></a> Four years after the publication of those findings, we analyse the current situation of ABs for headache and compare our results with those of previous years.</p><p id="par0015" class="elsevierStylePara elsevierViewall">This survey is part of an ambitious project which aims to publish a consensus document that may serve as a guide for neurologists who wish to incorporate ABs into their management of patients with headache.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">GECSEN's executive board designed a cross-sectional self-administered survey including open-ended and closed-ended questions (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). As in the 2012 survey, the SEN's scientific division sent the survey to all GECSEN members by e-mail. Survey respondents remained anonymous at all times. We gathered data on the following variables:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">(a)</span><p id="par0025" class="elsevierStylePara elsevierViewall">Responder data: sex, age, autonomous community, place of work (primary/secondary/tertiary hospital), whether they worked at a headache unit (yes/no), and whether they performed ABs in clinical practice (yes/no).</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">(b)</span><p id="par0030" class="elsevierStylePara elsevierViewall">Type of headache for which they administered AB: migraine (symptomatic treatment/prophylaxis), trigeminal autonomic cephalalgias (cluster headache, hemicrania continua), cervicogenic headache, tension-type headache, post-traumatic headache, occipital neuralgia, trigeminal neuralgia.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">(c)</span><p id="par0035" class="elsevierStylePara elsevierViewall">Technical details: nerve receiving AB (occipital [lesser or greater occipital nerve], supraorbital, supratrochlear, infratrochlear, lacrimal, external nasal, infraorbital, auriculotemporal, mental), type of anaesthetic agent and whether it was combined with corticosteroids, whether patients signed an informed consent form, and availability of a cardiopulmonary resuscitation system.</p></li></ul></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Qualitative variables are expressed as percentages and quantitative variables as means<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>SD.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0045" class="elsevierStylePara elsevierViewall">The survey was sent in February 2016 and completed by 39 neurologists (mean age: 41.74<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>9.73 years [range, 27-60]; 23 men [43.7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>9.92] and 16 women [38.94<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>9.01]). Most respondents were from Madrid (30.8%), Catalonia (15.4%), and Andalusia (10.3%). Sixty-one percent of respondents worked at tertiary hospitals, 33.87% at secondary hospitals, and only 5.12% worked at primary hospitals. Broadly speaking, 71.8% of respondents worked in headache units, and 76.9% regularly performed ABs (79.16% in tertiary hospitals).</p><p id="par0050" class="elsevierStylePara elsevierViewall">Treatment indications for AB included neuralgia (response to AB is a diagnostic criterion<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">15</span></a>), chronic migraine prevention (61.7%), episodic cluster headache (51.3%), and chronic cluster headache (66.7%). The main indications for AB are shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>. The nerves most frequently receiving ABs are the greater occipital nerve (94.9%), the supraorbitary nerve (56.4%), the lesser occipital nerve (53.8%), and the auriculotemporal nerve (33.3%) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). As shown in <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>, 31% of respondents perform ABs to the occipital nerves only, 13% also administer them to the supraorbital nerve, and 13% to the auriculotemporal nerve in addition to the other 2 nerves. Improvements in the frequency and/or intensity of pain are the parameters most frequently used to assess treatment response.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Regarding the technical details, 54% of respondents frequently asked patients to sign informed consent forms before the procedure, and 30% had a crash trolley or a cardiopulmonary resuscitation system available. All respondents used amides (lidocaine, bupivacaine, mepivacaine) for AB; there was no significant difference between amide types. Corticosteroids were only used to treat cluster headache.</p><p id="par0060" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows a comparative analysis of the data obtained in the 2012 and 2016 surveys.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0065" class="elsevierStylePara elsevierViewall">The results of the 2016 survey reveal that AB has become a frequently used therapeutic resource in clinical practice. Unlike in other, purely clinical neurology subspecialties, headache has a very active therapeutic component, combining conventional oral pharmacological treatment with more specialised techniques. Numerous studies conducted into AB over the past 10 years have enabled researchers to establish levels of evidence and grades of recommendation for different types of headache.<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">16–18</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">The results of the 2012 survey, however, reveal highly variable usage patterns.<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">14</span></a> Although the 2012 study included a smaller sample (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>19; age, 46.4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>8 years; 78.94% men), 78.94% performed ABs, a similar rate to that obtained in the 2016 survey. The greater participation in the second survey shows the widespread use of this technique. Although these results cannot be generalised, they suggest that neurologists specialising in headache management in 2016 are younger (35.89% were aged under 36) and have incorporated AB into their clinical practice.</p><p id="par0075" class="elsevierStylePara elsevierViewall">In 2012, ABs were indicated not only for patients with neuralgia of terminal branches of the trigeminal nerve, but also for migraine prophylaxis (52.9%), symptomatic treatment of migraine (35.3%), cluster headache (58.8%), hemicrania continua (35.3%), cervicogenic headache (64.75%), and tension-type headache (41.2%). Four years later, both the literature and our own clinical experience support similar indications for ABs, except for treating tension-type headache, as shown in the most recent version of the GECSEN's clinical practice guidelines for headache.<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">16–18</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">AB was most frequently administered to the occipital nerves (≥95%) in both 2012 and 2016, followed by supraorbital nerve AB. The type of anaesthetic agent (amines in all cases) used also varied greatly in 2012. We should note, however, that only 3 neurologists (15.78%) obtained informed consent from patients in 2012, compared to 54% in the 2016 survey. Although AB is a safe technique, it may also cause adverse effects<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">19–29</span></a>; these are usually mild and reversible. Obtaining informed consent is therefore essential (a model informed consent form is available on the SEN's website<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">30</span></a>).</p><p id="par0085" class="elsevierStylePara elsevierViewall">The comparative analysis of the results from the 2 cross-sectional surveys suggests that AB has entered mainstream clinical practice. Given the high variability in AB usage patterns, there is a need for prospective studies to be performed in order to gain a deeper knowledge of the technique and to gather more data on the indications, effectiveness, and response to AB for each nerve.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Our results should be interpreted with caution due to the study's sampling bias: the neurologists who completed the survey are very likely to perform ABs regularly to treat patients with headache or to have an interest in the procedure, and are therefore not representative of the population. Furthermore, as most of the questions in the survey were closed-ended, the results are more uniform but do not include other possible responses.</p><p id="par0095" class="elsevierStylePara elsevierViewall">Although pericranial nerve block is common in other medical specialties, performing the technique correctly does not necessarily result in an adequate or uniform response. The medical histories of headache patients should include pain characteristics and location, associated symptoms, response to symptomatic/preventive treatment, and the presence of risk factors for progression to chronic headache. It is also essential to differentiate between neuralgia of intra- or epicranial origin, based on pain location and characteristics,<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">31,32</span></a> and to systematically palpate the nerve territories and craniofacial structures where pain is located. Only in this way will we be able to provide our patients with individualised treatment and ensure an adequate response.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflicts of interest</span><p id="par0100" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1012466" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec971636" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1012467" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec971637" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Material and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of interest" ] 9 => array:2 [ "identificador" => "xack341541" "titulo" => "Acknowledgements" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-04-11" "fechaAceptado" => "2016-05-27" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec971636" "palabras" => array:6 [ 0 => "Anaesthetic block" 1 => "Headache" 2 => "Survey" 3 => "Infiltration" 4 => "Pericranial nerve" 5 => "Neuralgia" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec971637" "palabras" => array:6 [ 0 => "Bloqueo anestésico" 1 => "Cefalea" 2 => "Encuesta" 3 => "Infiltración" 4 => "Nervio pericraneal" 5 => "Neuralgia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Anaesthetic blocks, whether used alone or combined with other treatments, are a therapeutic resource for many patients with headaches. However, usage patterns by different professionals show significant heterogeneity.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The Headache Study Group of the Spanish Society of Neurology (GECSEN) designed a self-administered cross-sectional survey and sent it to all group members through the SEN's scientific area web platform in February 2016. The objective was to ascertain the main technical and formal aspects of this procedure and compare them with data obtained in a similar survey conducted in 2012.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 39 neurologists (mean age 41.74 years; SD: 9.73), 23 men (43.7 years; SD: 9.92) and 16 women (38.94 years; SD: 9.01) participated in this survey. Of these respondents, 76.9% used anaesthetic block in their clinical practice (79.16% in a tertiary-care hospital). The main indications were diagnosis and treatment of neuralgia (100%), prevention of chronic migraine (61.7%), episodic cluster headache (51.3%), and chronic cluster headache (66.7%). AB was used by 31% of the respondents to block only the lateral occipital complex, 13% also infiltrated the supraorbital nerve, and another 13% infiltrated the auriculotemporal nerve as well.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The indications for anaesthetic blocks and the territories most frequently infiltrated are similar to those cited in the earlier survey. However, we observed increased participation in this latest survey and a higher percentage of young neurologists (35.89% aged 35 or younger), indicating that use of this technique has entered mainstream clinical practice.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducción</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Los bloqueos anestésicos constituyen un recurso terapéutico en muchos pacientes con cefalea, de forma aislada o en combinación con otros tratamientos. Sin embargo existe una importante heterogeneidad en los patrones de uso entre los distintos profesionales.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y método</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se diseñó desde el Grupo de Estudio de Cefaleas de la Sociedad Española de Neurología (GECSEN) una encuesta transversal autoadministrada enviada a través de la plataforma del área científica de la SEN en febrero del 2016 a todos los miembros del grupo. El objetivo era conocer los principales aspectos técnicos y formales en relación con este procedimiento y compararlos con los datos obtenidos en una encuesta similar realizada en el año 2012.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Participaron 39 neurólogos (edad media: 41,74 años; DE: 9,73), 23 varones (43,7 años; DE: 9,92) y 16 mujeres (38,94 años; DE: 9,01). El 76,9% integraba los bloqueos anestésicos en su práctica clínica (el 79,16% en hospital de tercer nivel). Las principales indicaciones fueron: diagnóstico y tratamiento de las neuralgias (100%), prevención de migraña crónica (61,7%) y cefalea en racimos episódica (51,3%) y crónica (66,7%). El 31% de los encuestados bloquea solo el complejo occipital, el 13% infiltra además el nervio supraorbitario y otro 13% también el nervio auriculotemporal.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Las indicaciones del bloqueo anestésico así como los territorios infiltrados son similares en ambos años. Destacamos sin embargo una participación más activa en esta última encuesta y un porcentaje mayor de neurólogos jóvenes (el 35,89% tiene 35 años o menos) que indican una generalización de esta técnica en la práctica asistencial.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Santos Lasaosa S, Gago Veiga A, Guerrero Peral ÁL, Viguera Romero J, Pozo-Rosich P. Patrones de bloqueo anestésico de nervios pericraneales en el paciente con cefalea. Neurología. 2018;33:160–164.</p>" ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 930 "Ancho" => 1492 "Tamanyo" => 61516 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Main indications of anaesthetic block (2016). CH: cervicogenic headache; PTH: post-traumatic headache; CCH: chronic cluster headache; ECH: episodic cluster headache; HC: hemicrania continua; CM: chronic migraine; STM: symptomatic treatment for migraine.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 954 "Ancho" => 1568 "Tamanyo" => 94317 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Nerve territories treated with ABs (2016).</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 813 "Ancho" => 1620 "Tamanyo" => 69034 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Pericranial nerves habitually treated with ABs (2016). ATN: auriculotemporal nerve; SON: supraorbital nerve.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Demographic data</span><br><span class="elsevierStyleHsp" style=""></span>• Age<br><span class="elsevierStyleHsp" style=""></span>• Sex: male/female<br><span class="elsevierStyleHsp" style=""></span>• Autonomous community<br><span class="elsevierStyleHsp" style=""></span>• Headache unit: Yes/No<br><span class="elsevierStyleHsp" style=""></span>• Workplace: primary/secondary/tertiary hospital<br><span class="elsevierStyleHsp" style=""></span>• Do you usually perform ABs in clinical practice? Yes/No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Indications for ABs</span><br><span class="elsevierStyleItalic">Which of the following conditions do you usually treat with ABs?</span><br><span class="elsevierStyleHsp" style=""></span>• Migraine with/without aura: treatment for pain/aura/prophylaxis<br><span class="elsevierStyleHsp" style=""></span>• Chronic migraine<br><span class="elsevierStyleHsp" style=""></span>• Episodic tension-type headache<br><span class="elsevierStyleHsp" style=""></span>• Chronic tension-type headache<br><span class="elsevierStyleHsp" style=""></span>• Episodic cluster headache<br><span class="elsevierStyleHsp" style=""></span>• Chronic cluster headache<br><span class="elsevierStyleHsp" style=""></span>• Hemicrania continua<br><span class="elsevierStyleHsp" style=""></span>• Cervicogenic headache<br><span class="elsevierStyleHsp" style=""></span>• Post-traumatic headache<br><span class="elsevierStyleHsp" style=""></span>• Cranial neuralgias \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Technical details of ABs</span><br><span class="elsevierStyleItalic">Which of the following nerves do you usually block?</span><br><span class="elsevierStyleHsp" style=""></span>• Supraorbital nerve<br><span class="elsevierStyleHsp" style=""></span>• Supratrochlear nerve<br><span class="elsevierStyleHsp" style=""></span>• Infratrochlear nerve<br><span class="elsevierStyleHsp" style=""></span>• External nasal nerve<br><span class="elsevierStyleHsp" style=""></span>• Lacrimal nerve<br><span class="elsevierStyleHsp" style=""></span>• Infraorbital nerve<br><span class="elsevierStyleHsp" style=""></span>• Mental nerve<br><span class="elsevierStyleHsp" style=""></span>• Auriculotemporal nerve<br><span class="elsevierStyleHsp" style=""></span>• Greater occipital nerve<br><span class="elsevierStyleHsp" style=""></span>• Lesser occipital nerve<br><br><span class="elsevierStyleItalic">Which of the following anaesthetic agents do you usually use?</span><br><span class="elsevierStyleHsp" style=""></span>• Lidocaine<br><span class="elsevierStyleHsp" style=""></span>• Mepivacaine<br><span class="elsevierStyleHsp" style=""></span>• Bupivacaine<br><br><span class="elsevierStyleItalic">Do you use corticosteroids in addition to the local anaesthetic? Yes/No</span><br><span class="elsevierStyleItalic">Which parameter do you normally use to assess treatment effectiveness?</span><br><span class="elsevierStyleItalic">Do you ask patients to sign informed consent forms? Yes/No</span><br><span class="elsevierStyleItalic">Is a crash trolley readily available in the room where you perform ABs? Yes/No</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1714616.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Survey sent to the members of the Spanish Society of Neurology's Headache Study Group.</p>" ] ] 4 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">AB: anaesthetic block.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2012 survey (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>19) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2016 survey (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>39) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mean age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">46.4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41.74<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>9.73 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Men (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">78.94 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58.97 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Perform ABs (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">78.94 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">76.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Work at a tertiary hospital (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">68.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">61 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Obtain informed consent (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">54 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Migraine; symptomatic treatment (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Migraine; prophylaxis (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">52.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">61.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cluster headache (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">66.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hemicrania continua (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cervicogenic headache (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1714617.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Comparative analysis of the data obtained in the 2012 and 2016 surveys.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:32 [ 0 => array:3 [ "identificador" => "bib0165" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Peripheral nerve blocks and trigger point injections in headache management: a systematic review and suggestions for future research" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 3 | 9 |
| 2024 October | 16 | 7 | 23 |
| 2024 September | 24 | 4 | 28 |
| 2024 August | 23 | 7 | 30 |
| 2024 July | 21 | 7 | 28 |
| 2024 June | 20 | 4 | 24 |
| 2024 May | 23 | 3 | 26 |
| 2024 April | 28 | 4 | 32 |
| 2024 March | 57 | 6 | 63 |
| 2024 February | 28 | 3 | 31 |
| 2024 January | 37 | 5 | 42 |
| 2023 December | 40 | 9 | 49 |
| 2023 November | 41 | 13 | 54 |
| 2023 October | 46 | 12 | 58 |
| 2023 September | 35 | 9 | 44 |
| 2023 August | 24 | 5 | 29 |
| 2023 July | 31 | 3 | 34 |
| 2023 June | 31 | 7 | 38 |
| 2023 May | 34 | 5 | 39 |
| 2023 April | 24 | 2 | 26 |
| 2023 March | 25 | 6 | 31 |
| 2023 February | 22 | 11 | 33 |
| 2023 January | 17 | 8 | 25 |
| 2022 December | 44 | 3 | 47 |
| 2022 November | 54 | 5 | 59 |
| 2022 October | 65 | 9 | 74 |
| 2022 September | 57 | 14 | 71 |
| 2022 August | 51 | 6 | 57 |
| 2022 July | 41 | 7 | 48 |
| 2022 June | 55 | 7 | 62 |
| 2022 May | 51 | 7 | 58 |
| 2022 April | 63 | 6 | 69 |
| 2022 March | 79 | 11 | 90 |
| 2022 February | 86 | 5 | 91 |
| 2022 January | 79 | 6 | 85 |
| 2021 December | 75 | 12 | 87 |
| 2021 November | 52 | 12 | 64 |
| 2021 October | 37 | 13 | 50 |
| 2021 September | 39 | 12 | 51 |
| 2021 August | 28 | 9 | 37 |
| 2021 July | 25 | 6 | 31 |
| 2021 June | 26 | 5 | 31 |
| 2021 May | 32 | 13 | 45 |
| 2021 April | 98 | 22 | 120 |
| 2021 March | 50 | 11 | 61 |
| 2021 February | 21 | 9 | 30 |
| 2021 January | 30 | 9 | 39 |
| 2020 December | 34 | 9 | 43 |
| 2020 November | 39 | 11 | 50 |
| 2020 October | 31 | 10 | 41 |
| 2020 September | 40 | 8 | 48 |
| 2020 August | 37 | 11 | 48 |
| 2020 July | 30 | 6 | 36 |
| 2020 June | 41 | 7 | 48 |
| 2020 May | 28 | 15 | 43 |
| 2020 April | 20 | 5 | 25 |
| 2020 March | 33 | 8 | 41 |
| 2020 February | 35 | 12 | 47 |
| 2020 January | 37 | 4 | 41 |
| 2019 December | 41 | 10 | 51 |
| 2019 November | 30 | 7 | 37 |
| 2019 October | 42 | 10 | 52 |
| 2019 September | 45 | 4 | 49 |
| 2019 August | 47 | 9 | 56 |
| 2019 July | 49 | 18 | 67 |
| 2019 June | 52 | 11 | 63 |
| 2019 May | 119 | 22 | 141 |
| 2019 April | 58 | 38 | 96 |
| 2019 March | 19 | 9 | 28 |
| 2019 February | 27 | 15 | 42 |
| 2019 January | 12 | 7 | 19 |
| 2018 December | 12 | 4 | 16 |
| 2018 November | 32 | 8 | 40 |
| 2018 October | 20 | 12 | 32 |
| 2018 September | 24 | 11 | 35 |
| 2018 August | 11 | 4 | 15 |
| 2018 July | 12 | 2 | 14 |
| 2018 June | 11 | 4 | 15 |
| 2018 May | 24 | 1 | 25 |
| 2018 April | 8 | 8 | 16 |
| 2018 March | 1 | 5 | 6 |
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