The Journal of Headache and Pain

Official Journal of the "European Headache Federation" and of "Lifting The Burden - The Global Campaign against Headache"

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Volume 15 Supplement 1

Abstracts from the 4th European Headache and Migraine Trust International Congress: EHMTIC 2014

Open Access

EHMTI-0373. Adrenal suppression associated with greater occipital nerve and multiple cranial nerve blocks using triamcinolone

  • B Hywel1 and
  • N Silver1
The Journal of Headache and Pain201415(Suppl 1):I5

Published: 18 September 2014


CortisolCortisol LevelNerve BlockTriamcinoloneAdrenal Suppression


Greater Occipital Nerve (GON) and Multiple Cranial Nerve (MCN) blocks using local anaesthetics and corticosteroids have been used to treat various headache syndromes including Trigeminal Autonomic Cephalgias (TAC). We report cases where low cortisol levels have been seen in patients with TAC treated with GON/MCN blocks that included triamcinolone.


We report four cases of adrenal suppression in TAC patients treated with GON/MCN blocks.


The cases were collected retrospectively from a specialist headache clinic. Pituitary function tests prior to GON/MCN blocks were undertaken as part of their routine work up for TAC. Cortisol levels were repeated in the patients reported here due to varied nonspecific medical complaints.


Our cases include a 25 year old female with TAC who reported weight loss and leg pain following three MCN blocks in three weeks. Cortisol levels were found to be low on two separate occasions.

Another case is a 33 year old female treated with MCN blocks for TAC who was found to have low cortisol; the patient’s cortisol also failed to respond adequately to synthetic ACTH.

We aim to present another two patients, under ongoing investigation, who have had low cortisol levels associated with GON/MCN blocks for TACs.


Whilst adrenal suppression is a known side effect of steroid use, it has not been widely described in patients treated with GON/MCN blocks. These cases suggest that professionals using local nerve blocks containing steroids should be cautious of the potential for adrenal suppression, particularly when used on a repeated basis.

No conflict of interest.

Authors’ Affiliations

Neurology, Walton Centre For Neurology and Neurosurgery, Liverpool, UK


© Hywel and Silver; licensee Springer. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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