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Headache-Adviser Newsletter, Issue #24 Nerve Blocks For Severe Headaches
June 27, 2010

Nerve Blocks For Headaches

Today I wanted to let you know that this month's Headache Journal was entirely devoted to the subject of nerve blocks and injections for headaches and migraines. What is significant about this is that for the last couple of years, this is becoming more and more important in the field of headache treatment. Headache specialists and other pain management specialists are now recognizing that through the use of injections, we can send signals to the brain to dampen pain.

This is one thing most patients don't realize when a doctor offers trigger point injections or nerve blocks to treat headaches. The nerve blocks in particular may be around the occipital nerve at the back of the head or given on the face. There are nerves just above and below the eyebrow (as we all know when they start throbbing with a migraine)that can be utilized during a nerve block to send these signals to the deep part of the brain where a migraine starts.

Most often the blocks are a combination of lidocaine and steroid. A recent study in the journal Headache did indicate a better response when marcaine (a different numbing agent) was used in place of lidocaine and mixed with the steroid. Most often depo-medrol is used as the steroid.

Sphenopalantine Blocks

Another type of block (that I am willing to bet you haven't tried) is called a sphenopalantine block (huh?).

There is a nerve plexus or grouping of nerves at the back of the nose, just above the palate. This is called the sphenopalantine plexus and if blocked with lidocaine, it sends a direct message to the migraine headache generator in the brain and calms it down.

Before you can ask, no we do not squirt lidocaine up your nose with a needle. The blocks are done with nasal swabs soaked in the medication. The swabs a put in place with the patient lying down, and they stay there for 30 minutes. During that time the blood pressure is monitored as sometimes this block may cause the blood pressure to lower a bit and could cause light-headedness. This effect wears off within a few minutes after the block is finished.

Although many pain management doctors will do one block this way what they do not realize is that for status migrainosus a series of blocks is a must. We do these blocks once a day for 5 days to break severe headaches. 45% of patients are seeing improvement by day 3 and 70% of patients see full response by day 5.

Even if you have had one of these blocks done before, and it didn't work, it is definitely worthwhile talking to your doctor about getting the 5 day series performed. This may really help with your migraine headache symptoms.

Here's To Headache Free Days

Take care..

Mary Kay Betz MS RPA-C
Physician Assistant

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