Peripheral Nerve Block for Headaches

Summary: Chronic headaches are a pretty common problem. Some people continue to suffer from chronic headaches, migraine, and neck pain for years, despite using multiple medications. New studies show that many of these patients may benefit significantly from the peripheral nerve block. It is a relatively safe procedure that rarely causes any side effects and can be readily done in outpatient settings. In addition, the benefit from the procedure is almost instant.

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. Just take an example of migraine headaches. 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 to do something with blood vessels and thus prescribed even caffeine to manage such pains. However, now it is clear that migraine headaches are quite complex. Although, for example, some people with migraines have an aura, 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 headaches 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 due to poorly managed pain.

The doctor 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.

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 person can go home almost instantly after the procedure. Moreover, benefits from it are felt almost immediately.

By Gurpreet Singh Padda, MD, MBA