How to Treat Headaches with Nerve Blocks
Nerve blocks are used to block pain from chronic headaches, specifically migraines, tension headaches, cluster headaches and head pain from occipital neuralgia and trigeminal neuralgia. This procedure aims to minimize or block nerve impulses that relay pain signals to the brain and/or spinal cord.
Using a nerve block for headache treatment has been demonstrated to provide relief for patients with cluster headaches and help stop pain in a migraine cycle. Nerve blocks can also be diagnostic to determine sources of pain, such as in the case of occipital neuralgia.
A nerve block is performed by an experienced headache specialist with the injection of a local anesthetic or a combination of pain-relieving and anti-inflammatory drugs into or near a nerve that is problematic. The effects of nerve blocks can last for days or weeks.
Based on your headache diagnosis, you might benefit from different types of procedures.
Treating Your Occipital Nerves
Although the occipital nerves are positioned in the back of your head, they can also cause severe pain in the face or front of the head. Occipital nerve blocks involve the injection of a local anesthetic, such as lidocaine, or an anesthetic or steroid mixture into the occipital nerves. Since nerve impulses are never allowed to reach the brain, patients with chronic headache pain due to occipital neuralgia or severe migraine can experience great relief. Not all individuals are suited for this treatment modality. Most patients can experience pain relief within about 15 minutes of receiving an injection. Unfortunately, it is impossible for headache specialists to accurately predict who can benefit from nerve blocks and how long the treatment’s effects will last.
Supraorbital Nerve Block for Migraine or Head Pain
The supraorbital nerve is located above the eyebrows, in the bones of the forehead, and exits the skull above the eyes. If you experience severe pain in this region, your physician may recommend blocking the supraorbital nerve with an injection of local anesthetic or a combination of an anesthetic and a corticosteroid. This medication is usually injected where the supraorbital nerve exits. This prevents the nerve from transporting pain signals to the central nervous system, as well as closes receptors in the nerve that respond to pain.
Treating Your Trigeminal Nerves
Trigeminal nerves provide sensations in your face such as biting, chewing and swallowing. If you suffer from facial pain, blocking these nerves could help you manage your symptoms.
Injections are usually performed with neurolytic agents, more commonly to provide relief that can last up to a few months. Most individuals who undergo this treatment have been diagnosed with trigeminal neuralgia, atypical facial pain or herpes shingles causing pain in certain facial areas.
The procedure usually starts with an anesthetic injection, followed by steroid injections administered with X-ray guidance. The procedure takes about 30 minutes. Due to the anesthetic, you may experience immediate relief after treatment. Longer-term relief follows once the steroid becomes effective. You may need several injections to remain pain-free. Each individual case will vary, and it is impossible to predict how you will personally respond to the treatment.
Since complications can occur, it is important that you receive nerve block injections at a treatment center with experienced neurosurgical specialists. Some side effects can involve the nervous system, including pain, neurolysis, facial numbness and paresthesia. We can make a referral if you are a candidate for these specialized blocks.
Nerve block injections should not be viewed as a cure but as part of a well-balanced treatment plan that includes alternative therapies, medication and lifestyle changes. This treatment is typically used as a transitional therapy after beginning preventive medications for headaches while waiting for them to take effect. If you don’t respond to standard abortive medications such as triptans, NSAIDs, reasonable doses of opiates and ergotamine tartrate, then surgery may be recommended as an option. However, we can certainly keep trying different combinations of preventive therapy to help you get better.
Patients don’t typically receive more than three nerve block injections in a six-month period. If you don’t experience relief after a one- or two-week period, a physician will most likely try a second injection to see how you react.
In some patients, surgical intervention in the form stereotactic gasserian ganglion and retrogasserian ganglion ablative procedures can be considered. Microvascular decompression of the trigeminal nerve, particularly in younger patients, may be warranted. Other surgical considerations may include percutaneous stereotactic rhizotomy and stereotactic radiosurgery (Gamma Knife). The latter is a good treatment option for those patients with co-morbidities, high-risk medical illness, or pain refractory to prior surgical procedures. Percutaneous techniques are advocated for elderly patients, patients with multiple sclerosis, patients with recurrent pain after microvascular decompression, in and patients with impaired hearing on the other side.