Peripheral Nerve Block and Topiramate in the Treatment of Medication Overuse Headaches

Inclusion Criteria

• •1. Chronic migraine diagnosis according to International Classification of Headache-2 Disorders (ICHD)
• •2. w/o pregnancy or breastfeeding.
• •3. w/o acute or chronic psychiatric disorders.
• •4. w/o nephrolithiasis.
• •5. w/o medication of anticoagulant and antiaggregant.
• •6. w/o allergy to topiramate or bupivacaine.
• •7. w/o prophylaxis within the last three months with any of; propranolol, nebivolol, topiramate, valproate, venlafaxine, duloxetine, amitriptyline, flunarizine.
• •8. w/o previous history of peripheral nerve block, botulinum toxin or acupuncture.
• •9. w/o history of multiple sclerosis, movement disorders, epilepsy, stroke, and tumor.
• •J-w/o chronic systemic diseases including hypertension, cardiac insufficiency, diabetes, pulmonary disease, kidney disease, liver disease, and peripheral arterial disease.