AB233. SOH25_AB_143. Hydro dissection of greater occipital nerve for migraine treatment: a case report

Background: Migraines are a severe and debilitating type of primary headache. Targeting the greater occipital nerve (GON) using a nerve block has been previously demonstrated as a treatment option by inhibiting afferent nerve conduction from regions innervated by the GON. Hydro dissection, a minimally invasive technique involving injection of fluid to separate fascial layers and release entrapped nerves and tendons, has emerged as a potential treatment. Its use in migraine treatment has not been reported.

Case Description: We present the case of an 85-year-old female with recurrent migraine. Despite extensive conservative therapies, including medications and physical therapy, she continued to experience recurrent migraine. Intervention: the patient underwent ultrasound-guided bilateral occipital hydro dissection as a targeted approach to address perineural inflammation and nerve entrapment. Hydro dissection of the GON was performed bilaterally. A low concentration (5%) dextrose solution was used to free the tendons from surrounding scar tissue and muscle adhesions. The procedure was performed in a theatre setting. Outcome: following the hydro dissection procedure, the patient experienced improvement in migraine, with sustained improvement over two months, at follow-up. Functional outcomes, including daily activities, improved substantially. No complications were reported.

Conclusions: This case supports the potential role of dextrose hydro dissection as a safe, minimally invasive treatment option recurrent migraine. Hydro dissection offers an alternative to more invasive interventions and medications and warrants further investigation in the management of recurrent migraine.

Keywords: Greater occipital nerve (GON); hydrodissection; case report