Summary: A peripheral nerve block helps many people who have had chronic headaches, migraine, and neck pain for years, even after many drugs, new studies show. It is a fairly safe procedure that rarely causes side effects. It is done in the clinic, with no hospital stay. It brings relief almost at once. Chronic headaches are a common problem.
Headaches are hard to treat, because every patient is different. Worse, we still do not fully know why and how they happen. Doctors know a lot, but much is still unknown. The human nervous system is complex. Take migraine headaches. They look different from patient to patient. In some, the pain is dull and constant. In others, sudden attacks are common. The pain is often severe and crippling. Drugs help turn down the pain. But many people do not get enough relief from one treatment after another. For many, living with migraine headaches is like being in hell.
Doctors once thought migraine was about blood vessels. So they even gave caffeine for the pain. Now it is clear that migraine headaches are complex. For example, some people with migraines have an aura, a warning sign, so they can tell when a headache is starting. That points to a complex disease with many changes in the brain.
In many cases, the nerves that carry signals to the brain can help turn pain up or down. That is why people get relief from massage, acupressure, acupuncture and similar methods. New studies also show that blocking certain nerves may be one option for migraine headache treatments. A peripheral nerve block may help beat headaches in many patients.
The good thing about nerve blocks is that they are fairly easy to do, and the procedure is very safe. Doctors have been carrying out nerve blocks for several decades. These nerve blocks wear off, meaning that medications block nerves only for a short time. Yet a short block of certain nerves may give long headache relief in most cases. The same method is also used for other pain, like neck pain, peripheral neuropathic pain and diabetic peripheral neuropathy.
Nerve blocks work especially well to prevent, stop and treat migraine and cluster headache attacks. Doctors use a small needle to inject just under the skin. They use one of the well-known local anesthetics like lidocaine or bupivacaine. They may block nerves like the greater and lesser occipital, supraorbital, supratrochlear, cervical spinal root, and others.
Does it work? Yes. Studies show it is a very effective and safe way to beat headaches. In one study, doctors tested nerve blocks in 64 patients. Most were older women (average age 71) who had lived with headaches for years. Half had chronic migraine. The rest had episodic migraine, trigeminal autonomic cephalalgia, and occipital neuralgia. On average, these patients had headaches 23 days a month.
Headaches this severe and constant lead to many other health problems. So half of these women had high blood pressure and high cholesterol. One-fourth also had arthritis. Half had depression and anxiety. It means that nerve blocks would do more than ease headaches. They would also ease other health problems caused by poorly controlled pain.
The doctors carried out an average of four nerve blocks on these patients. The results were very encouraging. Patients reported benefit in 73% of all headaches, and in 81% for chronic migraine. Other painful conditions that cause headaches showed similar gains.
What is good about nerve block is its excellent safety record. It can prevent drug overuse. Studies also show it works even for older adults who have lived with this pain for a long time.
A peripheral nerve block is a fairly simple procedure. It needs no hospital stay and is done in the outpatient department. You can go home almost right after. And you feel the benefit almost at once.
Frequently asked questions
Are nerve blocks for headaches safe?
Yes. A peripheral nerve block has an excellent safety record and rarely causes side effects. Doctors have performed nerve blocks for several decades. The effect wears off: the medicine blocks the nerve only for a short time. It can also prevent drug overuse. It works in older adults who have lived with headaches for years.
How is a nerve block for headaches done?
The doctor uses a small needle to inject a well-known local anesthetic, such as lidocaine or bupivacaine. It goes just under the skin near the nerve. Common targets are the greater and lesser occipital nerves at the back of the head. Others are the supraorbital and supratrochlear nerves above the eye, and cervical spinal roots in the neck. It is done in the outpatient clinic, with no hospital stay.
How well do nerve blocks work for migraine?
One study had 64 patients. Most were older women with an average age of 71. They had headaches about 23 days a month. Doctors gave an average of four nerve blocks. Patients reported benefit in 73% of all headache types and in 81% of those with chronic migraine. Blocking a nerve for a short time can bring headache relief that lasts much longer.
What types of headaches can a nerve block treat?
Nerve blocks are used to prevent, stop and treat migraine and cluster headache attacks. The study on this page also included episodic migraine, trigeminal autonomic cephalalgia and occipital neuralgia. The same method is used for other pain. That includes neck pain, peripheral neuropathic pain and diabetic peripheral neuropathy. It is used most when years of drugs have not brought enough relief.
How quickly does a nerve block for headaches work?
You feel the benefit almost at once. Because the procedure is simple and done in the outpatient department, there is no hospital stay. Most people go home almost right away. Even though the anesthetic blocks the nerve only briefly, it gives long headache relief in most cases.
Dr. Gurpreet Singh Padda, MD, MBA, MHP
