Israel Medical Association Journal

Background: Greater occipital nerve (GON) blocks are used in migraine management. While ultrasound-guided proximal GON blocks at the C2 level (GONC2) have been suggested to provide more sustained benefit, distal landmark-guided GON blocks are used due to their simplicity and accessibility.

Objectives: To evaluate distal GON blocks as an initial procedural approach for migraine; to assess the effect of subsequent proximal GONC2 blocks in patients who did not respond to an initial distal block.

Methods: We conducted a retrospective cohort study of adult migraine patients treated at a tertiary pain clinic between May 2022 and July 2023. Patients received either distal landmark-guided GON blocks or ultrasound-guided proximal GONC2 blocks as part of routine clinical care. Monthly migraine days (MMD) were assessed at baseline, 1 month, and 3 months following treatment.

Results: The cohort included 54 patients (27 distal, 27 GONC2). Baseline characteristics were comparable between groups. A significant overall effect of time on MMD was observed (P = 0.017). In the distal group, MMD decreased significantly at 1 month (P < 0.001) but not at 3 months. In the GONC2 group, MMD decreased significantly at both 1 month (P < 0.001) and 3 months (P = 0.001). No significant between-group differences were found at 1 month (P = 0.142) or 3 months (P = 0.509).

Conclusions: Distal GON blocks provide meaningful short-term reduction in migraine frequency and represent an effective, accessible initial interventional option. Proximal GONC2 blocks demonstrate sustained benefit and may be considered in selected patients. These findings support a pragmatic, stepwise approach to procedural migraine management.

Objectives: To assess the clinical course and outcome of demented elderly patients with severe disabilities by feeding mode.

Methods: The study was conducted in a skilled nursing department of a major psychogeriatric hospital in Israel. Eighty-eight patients aged 79 ± 9 years were followed for 17 months: 62 were fed by nasogastric tube and 26 were orally fed. The groups were compared for background characteristics, underlying medical condition, functional impairment, clinical and nutritional outcomes, and survival.

Results: Tube feeding had no beneficial effect on clinical and nutritional outcomes or on healing preexisting pressure ulcers, compared with oral feeding. Very few patients on tube feeding showed signs of discomfort, partly because of low cognitive function. Survival was significantly higher in the tube-fed patients (P < 0.001), which could be partly explained by the different case mix (i.e., the underlying diseases)

Conclusions: Tube feeding seems to have no nutritional advantage in severely demented elderly patients. Median survival was longer in tube-fed individuals who had no acute co-morbidity. However, since tube feeding does not add to patient pain and discomfort, it should not be contraindicated when it complies with the values and wishes of patients and their families.