Greater Occipital Nerve Block Versus Metoclopramide

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.