Monday, May 29, 2023

Nerve Block Injection For Migraines

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What Is A Nerve / Pain Receptor Block

Occipital Nerve Block Injections 1 hour later. Headache and Migraine treatments

A nerve block is an injection of anesthetic on or near a nerve. The injection temporarily “blocks” the pain in the same way a dentist numbs your jaw before working on your teeth. The injection also contains a corticosteroid to reduce inflammation of the nerve.

The occipital nerves run from the spinal cord, through the neck muscles, to the back of the scalp . Two pairs of nerves originate near the second and third cervical vertebrae of the neck. The greater occipital nerve is a branch of the C2 spinal nerve. The lesser occipital nerve is a branch of the C3 spinal nerve. Nerve inflammation causes pain at the base of the skull that radiates to the top of the head, the temple, the forehead, or the eye.

Nerve blocks may be given along with trigger point injections in the neck muscles.

Occipital nerve blocks may relieve pain from:

  • Occipital neuralgia, an electric-like shooting, stinging, or burning pain at the back of head.
  • Incision pain that can occur after surgery for Chiari, C1-C2 spine fusions, or a craniotomy at the back of the skull.
  • Shingles of the scalp .
  • Tension or cluster headaches.

Nerve block injections may be done up to 3 times to calm down the overactive nerves, depending on the physician and patient preference, as well as insurance requirements.

What Does The Injection Involve

Your child will be asked to sit on the bed and keep as still as possible for the injection. The doctor will clean the area with antiseptic solution which may feel a bit cold. He or she will then stand behind your child and inject a combination of local anaesthetic and steroid medicine around the occipital nerve. This can be uncomfortable as the injection irritates and numbs the nerve. The injection is done above the hairline.

Where Is The Occipital Nerve Location

The greater and lesser occipital nerves exist on the back of the head above the neck area. The occipital nerves are located at the base of the neck and run from the top of the spinal cord up through the scalp. There are two occipital nerves on each side of the head which supply feeling to the posterior scalp from the top portion of the neck up to the crown of the head.

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How Long Does It Take For An Occipital Nerve Block To Work

The best responses to an occipital nerve block usually come from patients whose pain is relatively recent rather than long-standing. If the first occipital nerve block doesnt relieve the patients symptoms in a week or two, it may be necessary to have a second injection. Additional nerve blocks may be done to keep the symptoms under control. While occipital nerve blocks are not for everyone, for some, they can prove to significantly control and mediate their chronic pain.


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So What Happens When Nerve Blocks Make The Pain Worse

Nerve block uses, duration, nerve block procedure &  side effects

Remember that nerve blocks can be divided into diagnostic and therapeutic blocks, discussed in further here. And remember that diagnostic blocks contain a small volume of local anesthesia, such as lidocaine or bupivacaine. These are the blocks that I and my colleague migraine surgeons perform, and they shut down all signals traveling through the nerve. Even if the needle were to hit the nerve which would cause worse pain, the anesthetic in these injections rapidly shuts the pain signal off and so these injections rarely worsen headache pain.

These diagnostic blocks are different from the blocks performed by neurologists, that are supposed to be therapeutic. These therapeutic nerve blocks often also include steroids, and these steroids are diluted in a larger volume of liquid. This is done because the neurologists are often not able to localize the nerve exactly, as opposed to the surgeon who sees these nerves and their location frequently. The diluted steroid is meant to spread around the region, decreasing inflammation of anything that is inflamed in the area, as a kind of shotgun approach to migraine pain control.

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How Do Trigger Point Injections Work

The anesthetic medication will be injected into the muscle and will block pain receptors within the nerves surrounding the muscle, and, in turn, reduce the pain signals sent to the brain. If steroid medication is used, it reduces the inflammation and swelling of tissue around the nerves, which may help reduce pain. The needle without medication may even provide independent benefits mechanically. The needle separates, relaxes and lengthens the muscle fiber to provide further pain relief. This approach is called needling and may be used in patients with allergies to anesthetic medication.

What Does Gon Block Involve

Your doctor will usually feel around the back of your head to locate the best place for the injection. The injection involves a fine needle. Some people find the injection stings a little bit, but generally its well tolerated and only takes a few minutes.

You will be monitored for about 15 minutes after the injection to make sure you feel ok before you go home.

The area around the injection may feel numb and tender for a few hours after the injection. Some people find the numbness spreads across the side of the head that has been injected. You will be asked to keep the injection site dry for 24 hours following the procedure.

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Are Nerve Blocks Safe

Nerve blocks are considered a generally safe procedure. They are performed in the clinic without the need for fluoroscopy or EMG guidance. The procedure only takes about 5-15 minutes. Following the procedure, the patient is observed for approximately 30 minutes.

Most patients are able to ambulate without assistance and drive following nerve blocks. Many are eager to return directly to work because they are fully functioning without disability. This increase in productivity improves the patients quality of life greatly. Side effects are generally mild and resolve within hours.

Common side effects include injection site soreness , numbness and dizziness. This typically resolves after several minutes to an hour and is usually mild. Eyelid drooping may occur with auriculotemporal blocks and is also transient and mild. Locally-acting steroids rarely cause undesirable cosmetic side effects such as hair loss and loss of underlying fat and loss of skin color at the site of the injection.

In addition, steroids may suppress the immune system and can cause local infections know as abscesses. This is why steroids are avoided by most headache specialists except in the rare circumstance of cluster headaches and only in the back of the head over the occipital nerve. Epinephrine is typically avoided, as is it reduces blood flow and can cause serious skin injury .

Who Should Receive Trigger Point Injections

Anatomical Regional Targeted (ART) nerve blocks for Migraine Headaches

Patients that have specific trigger points that can be elicited with palpation may experience the most relief from injections. They may be very helpful for immediate relief for severe pain in patients with an individual headache or migraine attack, or can help treat an overall worsening of head pain in patients with chronic headache disorders who are having an exacerbation.

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How An Occipital Nerve Block Is Performed

You’ll have an intravenous line put in your arm. Your doctor will set up several monitors, including heart, pulse, and pulse. Your healthcare team will monitor your vital signs. Your doctor will give you IV medicine to reduce your anxiety and give you some pain relief.

Your doctor will clean your skin where the injection will be given. A local anesthetic will be injected so that you won’t feel any pain during the procedure. The medicine for the occipital block will be inserted near your occipital nerve through a small needle near the base of your skull.

Your headache may get worse briefly when the medicine is injected. This is a sign that the medicine is going to the right place. The procedure usually lasts around 15 minutes.

Are Trigger Point Injections Safe

The most common side effects are temporary pain and numbness at the injection site. Infection and bleeding may occur at the injection site, but this can be avoided by cleaning the site before injection and applying pressure to the site after injection. Patients may also experience light-headedness after injections.If steroid injections are used, repeated dosing may cause a loss of hair, fatty tissue accumulation, or loss of muscle thickness at the injection site.

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Occipital Nerve Block For Migraine Relief

Migraines can stop your day in its tracks. This debilitating neurological condition can affect work, school, and home life. Migraines are becoming increasingly common in our nation. In fact, more than 15 percent of Americans aged 18 years or older have reported a migraine or severe headache in the past 3 months, according to the Center for Disease Control . Treatment for migraines differs from medications to procedures based on the individual and their medical history. Occipital Nerve Blocks is a minimally invasive, in office procedure which aims to relieve pain and inflammation in the back of the head. No one should have to suffer through headaches or migraines if they can be prevented.

What is an Occipital Nerve Block procedure?

An Occipital Nerve Block is an injection of an anesthetic and steroid into the occipital region of the head. Occipital Nerve Blocks offer immediate pain relief and relieve inflammation over the course of a few days or weeks. An Occipital Nerve block can be repeated every few months or so, which means if you have chronic headaches or migraines, you could receive treatment as much as three or four times a year depending on your doctors recommendation. This procedure is often done in conjunction with other kinds of nerve blocks that target other areas of the head including the supraorbital nerve block and the supratrochlear nerve block .

What does the procedure look like?

What are the risks?

Who is a good candidate for this procedure?

Occipital Nerve Block: Why Is It Used

Greater Occipital Nerve Block for Acute Treatment of Migraine Headache ...

We use occipital nerve block to diagnose and treat a type of tension headache that is most likely due to:

  • Occipital neuralgia: A neurological condition caused by inflammation or injury to the occipital nerves, the nerves that run from the top of the spinal cord through the scalp
  • An irritation of a nerve in the back of your head

Many people who suffer from pain caused by occipital tension headaches experience relief of their symptoms with this treatment.

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How Long Will An Occipital Nerve Block Last

There’s no way to predict how long an occipital nerve block will last. It varies for each person. Some people experience pain relief that lasts for months. For others, it’s not effective or lasts only a few days. If you experience relief but it’s short-lived, you may want to try again.

There’s a limit to how many steroid injections you should have. Your doctor will talk to you about how often you can have them.

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Injection Procedures For Cervicogenic Headache

Injection techniques involving the use of anti-inflammatory or pain reducing medications can often provide enough pain relief and are minimally invasive. These procedures also allow for other forms of manual and non-invasive therapeutic treatments to take place in a comfortable and patient compliant manner. A few injection techniques for pain-relief from CGH are discussed below.

Injection techniques for pain relief from CGH have not been well studied in controlled clinical trials. Also, there have been inconsistent reports of effective pain-relief from these procedures. The effectiveness and safety of epidural steroid injections for CGH have not been approved by the FDA, and there is always a small risk of serious side effects, such as stroke or paralysis. Other risks and complications include bleeding, infections, and allergic reactions following injection of medications.

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What Happens After Treatment

Most patients can walk around immediately after the procedure. After being monitored for a short time, you can usually leave the office or suite.

The effects of the local anesthetic may wear off in a few hours, but the effects of the steroid begin to increase over the next several days. You may notice a slight increase in pain as the numbing medicine wears off.

You may be asked to keep a daily pain diary to determine if the procedure was effective.

Types Of Nerve Blocks

Migraine Cure Nerve Block | Auburn Medical Group

Various areas of pain require different nerve block types. Below are a few of the available nerve blocks and some parts of the body where they are used.

  • Trigeminal nerve blocks
  • Maxillary nerve block
  • Sphenopalatine nerve block
  • Cervical epidural, thoracic epidural, and lumbar epidural block
  • Cervical plexus block and cervical paravertebral block
  • Brachial plexus block, elbow block, and wrist block
  • Subarachnoid block and celiac plexus block

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Understanding Your Occipital Nerves

Your occipital nerves are a group of nerves that originate from the C2 and C3 nerves in your cervical spine .

There are three major occipital nerves:

  • Your greater occipital nerve
  • Your lesser occipital nerve
  • Your third occipital nerve

These nerves control the sensations around the back and top of your head, which are areas where many migraine sufferers experience symptoms.

This point is an important one, as occipital nerve blocks arent for all migraine patients. If your migraines tend to start in your neck, at the base of your skull, or around the back or top of your head, the chances are good that an occipital nerve block can help.

If your migraines follow a different path, were happy to discuss other options with you, such as Botox® injections, magnesium IV infusions, and biofeedback.

Finding The Best Migraine Headache Treatment

The good thing about nerve block and Botox treatments is that they are safe, effective, and nonsurgical procedures for migraine management. Compared to a nerve decompression which is considered as a migraine surgery, nerve block and Botox only require injections to targeted areas to relieve pain.

But before proceeding with a procedure, its best to first weigh the pros and cons of each treatment to help determine whether they are right for you:

Nerve block Instant pain relief since injections can immediately take effect within a few minutes Can be used in between Botox treatments for migraine Can lessen the need for daily migraine medications Results can last for several months Injection site reactions such as soreness, bruising, and bleeding Slight dizziness after the procedure Risks of infection and allergic reaction to the medication
Botox No downtime Effectively cuts down on the frequency of migraine days Can be used for long-term migraine therapy Results can last for several months May take 2 to 4 weeks to feel the relieving effects Comes with minor pain and swelling at the injection site May also experience neck pain, muscle weakness, and slight headache as a side effect Rarely, adverse effects may include droopy eyelid, allergic reaction, difficulty breathing and speaking

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What Is Greater Occipital Nerve Block

A Greater Occipital Nerve block is an injection which contains small dose of local anaesthetic and/or steroid which is injected around the greater occipital nerve. The injections may be given on one side, or on both.

The greater occipital nerves travel up each side of the back of the head. People who often have headaches may find this nerve is oversensitive. The GON block aims to help by reducing the level of pain for a period of time.

Nerve Blocks As Transitional Therapy

Figure 3 from Nerve blocks in the treatment of headache

Headache medicine experts commonly use nerve blocks as transitional therapy or bridge therapy. Meaning, while weaning off an offending attack agent that may be causing medication-overuse-headache and/or while initiating a preventive therapy, nerve blocks are utilized to assist with pain during the transition.

Nerve blocks are frequently used in between Botox treatments while the effectiveness of the treatments may be wearing off. Due to restrictions on the FDA-approved treatment protocol, Botox injection treatments must not be repeated until 12 weeks have passed since the last dose.

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Are They Effective

The majority of research examines the effectiveness of occipital nerve blocks on migraine headaches. However, according to a 2021 article, a 26-year-old pregnant person found that their migraine headaches improved with a combination of nerve blocks that included a supraorbital nerve block.

According to the United Kingdoms National Health Service , occipital nerve blocks work for approximately 60% of people with migraine. These nerve blocks may be even more effective for other types of headache.

The group also notes that 35% of people with migraine do not experience improvements in their headaches, and for 5% of people, their headaches may temporarily worsen for a few days or a week.

One 2019 study looked at the effectiveness of occipital nerve blocks for treating migraine headaches. A total of 190 patients who had experienced migraine headaches were given occipital nerve blocks as a treatment.

The researchers found that 27% of the people reported significant or immediate pain relief, and 42% of the people experienced a reduction in pain. Only 3% of the people in the study reported an adverse reaction.

Another 2018 retrospective cohort study looked at how effective occipital nerve blocks were for treating migraine headaches. A total of 562 patients participated in the study over a 5-year period.

Over 82% of the participants reported having moderate or significant pain relief after their occipital nerve block treatment.

A doctor will administer the nerve block.

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