Summary: A peripheral nerve block benefits many people who have suffered from chronic headaches, migraine, and neck pain for years despite using multiple medications, new studies show. It is a relatively safe procedure that rarely causes any side effects, is readily done in outpatient settings, and brings almost instant benefit. Chronic headaches are a pretty common problem.
Headaches are challenging to treat, as every patient is different. Even worse, why and how these headaches occur remains unclear. Of course, doctors know a lot about them, but much remains to be discovered. After all, the human nervous system is complex. Take migraine headaches as an example. They have varied presentations in patients. In some, they may be dull and chronic. In others, acute headache attacks are quite common. Often, pain is severe and debilitating. Medication helps lower pain sensation; however, many fail to gain sufficient benefit from different treatments. For many, living with migraine headaches is like being in hell.
There were times when doctors thought that it had something to do with blood vessels and thus prescribed even caffeine to manage such pains. However, now it is clear that migraine headaches are quite complex. For example, some people with migraines have an aura, so they can tell when their headaches begin. This indicates the complexity of pathology and different changes in the brain.
However, in many cases, nerves carrying signals to the brain can help modulate pain sensation. That is why people benefit from massage, acupressure, acupuncture, and similar modalities. In addition, new studies show that blocking specific nerves may be one of the options for migraine headache treatments. A peripheral nerve block may help overcome headaches in many patients.
The good thing about nerve blocks is that they are relatively easy to carry out, and it is a highly safe procedure. Doctors have been carrying out nerve blocks for several decades. These nerve blocks are reversible, meaning that medications block nerves for a short period. However, blocking certain nerves for a short period may provide prolonged headache relief in most cases. This technique is also suitable for managing other pains like neck pain, peripheral neuropathic pain and diabetic peripheral neuropathy.
Nerve blocks are especially effective in preventing pain, aborting, and treating migraine and cluster headache attacks. In the procedure, doctors use a small needle, subcutaneously injecting some of the well-known local anesthetics like lidocaine or bupivacaine. They may block nerves like greater and lesser occipital, supraorbital, supratrochlear, cervical spinal root, and others.
Does it work? Yes, studies show that it is a highly effective and safe way of overcoming headaches. In one of the studies, doctors tested nerve blocks in 64 patients. The majority of them were older women (average age 71), living with headaches for years. Half of them had chronic migraine, and others had episodic migraine, trigeminal autonomic cephalalgia, and occipital neuralgia. These were patients reporting headaches on average for 23 days a month.
Such severe and constant headaches lead to many other health issues. Thus, half of these women were living with hypertension and high cholesterol. One-fourth of them also had arthritis. In addition, half of them had depression and anxiety issues. It means that nerve blocks would not just help overcome headaches but also reduce the severity of other health issues caused by poorly managed pain.
The doctors carried out, on average, four nerve blocks on these patients, and the results were really encouraging, with a reported benefit in 73% of all headaches, and this benefit was 81% for chronic migraine. Similar benefits were reported in other painful conditions causing headaches.
What is good about nerve block is its excellent safety profile. It can prevent medication overuse. Moreover, studies show that this procedure works even for older adults who have been living with these chronic pains for quite a long time.
A peripheral nerve block is a relatively simple procedure that does not require hospitalization and can be carried out in the outpatient department. It means that a person can go home almost instantly after the procedure. Moreover, benefits from it are felt almost immediately.
Frequently asked questions
Are nerve blocks for headaches safe?
Yes. A peripheral nerve block has an excellent safety profile and rarely causes side effects. Doctors have performed nerve blocks for several decades, and the effect is reversible: the medicine blocks the nerve only for a short time. It can also prevent medication overuse, and 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, just under the skin near the nerve. Common targets are the greater and lesser occipital nerves at the back of the head, 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?
In one study of 64 patients, most of them older women with an average age of 71 who 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 technique is used for other pain, including neck pain, peripheral neuropathic pain and diabetic peripheral neuropathy, especially when years of medication have not brought enough relief.
How quickly does a nerve block for headaches work?
The benefit is felt almost immediately. Because the procedure is simple and done in the outpatient department, there is no hospitalization, and most people go home almost right away. Even though the anesthetic blocks the nerve only briefly, it provides prolonged headache relief in most cases.
Dr. Gurpreet Singh Padda, MD, MBA, MHP
