Clinical Observation Of Glucocorticoid In The Treatment Of Occipital Neuralgia And Its Effect On Serum Substance

Objective To investigate whether glucocorticoid affects parameters related to recovery from occipital neuralgia. To observe the clinical efficacy of glucocorticoid on occipital neuralgia(ON) and effection on SP in serum. To investigate the action of SP on the pathogenesis of ON and its clinical significance. To investigate the possible mechanism of glucocorticoid in treating ON.Methods Patients as described by The International Headache Society were randomly divided into 4 groups: group A, in which patients were given local occipital nerve block for one time; group B, in which patients were treated with intravenous dexamethasone 10 mg once a day for 3 days; group C, in which patients were received oral methylprednisolone tablets(medrol) 52 mg taken at a draught for 3 days; group D, in which patients were received oral ibuprofen 200 mg thrice daliy for 5 days. Outcome measures were evaluated before and after treatment in hour 2, week 1, month 2 and followed up in month 6 consisting of visual analog scale(VAS) and migraine headache index(MHI). The serum concentration of substance P(SP) in the external jugular vein was detected by radioimmunoassay in 1 week and 6 months after the procedure.Results Statistical analysis was made for 80 subjects. There were no differences between the group A and group B in VAS(P > 0.05). Compared with group D, patients who received occipital nerve block, intravenous dexamethasone and oral medrol had longer analgesia effectiveness from baseline(P<0.05). The MHI score four groups changed for an average reduction of 62%, 63%, 61%, 42%(P<0.05). The success rate of four therapies was 70.8%, 68.4%, 66.7%, 38.5%. The serum concentration of SP in the external jugular vein of four groups pre-administration was higher than normal value(P<0.05). After treatment the SP in blood of four groups were lower than those in pain occurring(P<0.05) and the group D was always higher than group A, B, C(P<0.05). No complications were reported in follow-up 6 months.Conclusion Using glucocorticoid to control neuropathic pain had similar effect with local occipital nerve block and all of them were better than oral ibuprofen. However, intravenous dexamethasone lead to slightly more rapid rates of improvement in pain than oral medrol. Intravenous dexamethasone could be an alternative therapy for treatment of patients with occipital neuralgia.