Chronic migraine is a debilitating neurological disorder that significantly affects patients' daily functioning, mental health, and quality of life. Management typically includes acute and preventive treatments, but effectiveness can be limited due to medication overuse or delayed onset of action. OnabotulinumtoxinA injections provide proven long-term preventive benefits, while Greater Occipital Nerve (GON) block offers rapid but short-term relief. Although both treatments are used individually, evidence on the combined effect is limited. This randomized controlled trial aims to evaluate the efficacy and safety of combining OnabotulinumtoxinA injections with GON block, assessing improvements in headache frequency, severity, and patient quality of life compared to single therapy.
Diagnosis of chronic migraine according to the International Classification of Headache Disorders, 3rd edition (ICHD-3): headache occurring on ≥15 days per month for more than three months, with at least 8 days per month exhibiting migraine features. (International Headache Society, 2013)
Age > 18 years
Stable preventive migraine regimen for at least two months prior to recruitment
Co-morbid other
Prior treatment with BoNT-A or GONB for headache within the previous 3 months.
Known hypersensitivity to BoNT-A or local anesthetics.
Cervical anatomical abnormalities that hinder proper localization of injection sites or compromise the safety of the procedure
Beni-Suef University
Lead sponsor
Cairo University
Collaborator