Background: Headache is one of the frequent human pains and it may indicate serious disease or represent only tension, exhaustion, or a migrainous disorder.
Objectives: The purpose of this study is to evaluate the effectiveness of ultrasound-guided bilateral greater occipital nerve blockade for the treatment of PDPH in patients underwent spinal anesthesia by bilateral injection of lidocaine 2% 40 mg and dexamethasone 8 mg in a total volume of 4 mL.
Patients and Methods: The ethics committee at Al-Azhar University approved this prospective randomized clinical study, and patients written informed consent was obtained. The study was carried out at Al- Azhar University Hospitals (Al-Hussein and Bab El-Sharia).  This study included 50 patients of both genders, admitted for spinal anesthesia carried out at Al- Azhar University Hospitals (El-Hussein and Bab El-Sharia).They were randomly allocated into two equal groups:
Group (A): Patients received bilateral injection of lidocaine (40 mg) and dexamethazone (8 mg) in a total volume of 4 mL. Injection were done by ultrasound (sonosite) using the linear probe. Block and assessment were done. Using linear probe, 22 G needle used at depth less than 2 cm until greater occipital artery was visualized as a landmark, then local anesthetics were injected medially and surrounding the artery.
Group (B): Patients received conventional treatment such as (bed rest, hydration, Acetaminophen, Caffeine, NSAIDs and opioids).
In both groups: We gave 25 mg pethidine to control surgical pain
If visual analogue scale (VAS) was greater than 4, Acetaminophen, Caffeine, NSAIDs and opioids were given.
Results: Regarding the requirement of analgesia, there was a significant statistical difference between the two groups. In the injection group, There was significant statistical difference in headache intensity between the two groups at 1, 6 and12 h after the injection, 8 out of 25 patients only needed analgesia in the form of paracetamol and NSAI (ketorolac,30 mg), while in the medical group all 25 patients needed analgesia in form of (paracetamol) and NSAI(ketorolac 30mg). Regarding the total dose of paracetamol, there was a significant statistical difference between the two groups. Regarding the total dose of NSAIDs (ketorolac), there was no significant statistical difference between the two groups.
Conclusion: Bilateral ultrasound-guided injection of GON block is an easy, minimally invasive, easy and cost-effective technique and may be considered before the utilization of a blood patch.