Greater Occipital Nerve Block Versus Metoclopramide
Greater Occipital Nerve Block Versus Metoclopramide
We are comparing a type of nerve block called greater occipital nerve block versus standard
 therapy among patients who present to an emergency department for acute migraine. This is a
 randomized, double-blind, double dummy study. The greater occipital nerve block will be
 performed bilaterally with bupivacaine 0.5%. Standard therapy is metoclopramide 10mg IV.
Inclusion Criteria:

 Eligible patients are adults who present with an acute moderate or severe headache meeting
 migraine headache criteria, as defined by the International Classification of Headache
 Disorders-3β (1.1, migraine without aura). Patients who meet criteria for Probable Migraine
 without Aura (1.5.1) will also be included, provided they have had at least one similar
 attack previously.

 Exclusion Criteria:

 Patients will be excluded if informed consent cannot be obtained, if there is concern for a
 secondary cause of headache, if the maximum documented temperature is greater than 100.3
 degrees, for a new objective neurologic abnormality, skull defect, suspected infection
 overlying injection site, known bleeding disorder, ongoing use of anti-platelet agents
 including P2Y12 platelet inhibitors (clopidogrel, prasugrel, ticagrelor), heparins,
 warfarin, or 10a inhibitors (rivaroxaban, apixaban, edoxaban, fondaparinux), prior
 treatment with a greater occipital nerve block, allergy to the investigational medications,
 pheochromocytoma, seizure disorder, Parkinson's disease, use of MAO inhibitors, and use of
 anti-rejection transplant medications.