17 Feb Interventional Pain Management for Migraine Headaches
Migraine headaches are often difficult to treat. A patient may require preventive therapy in addition to medications for pain relief. Adults and children with migraines have more anxiety and depression, and the total healthcare costs for families with migraine sufferers are 70% higher than those who do not have headaches. Research shows that early treatment with migraine agents can help, but interventional pain management is being used more and more for prevention of headaches.
Peripheral Nerve Blocks
A peripheral nerve block is a frequently used interventional procedure for the treatment of headaches. The treatment consists of administration of medication via a small needle injected near a nerve. The nerves associated with headaches are located at the back of the skull (occipital nerves), and they are also near the temples and above the eyebrows (trigeminal nerve branches). The medications used for numbing include bupivacaine and lidocaine, which are local anesthetics, as well as corticosteroids to reduce inflammation.
A peripheral nerve block works by shutting down overactive pain signals. After the injections, areas of the head become numb. Benefits of a peripheral nerve block last longer due to decreased pain signals sent to the brain. A successful peripheral nerve block will last for several days to several weeks, and this may be more effective with each following injection. Nerve blocks are used for a cluster headache, migraine headache, occipital neuralgia, and cervicogenic headache.
In addition to blocking the nerve signals using anesthetics, the nerve can be partially destroyed using a neurolytic agent, such as absolute alcohol or phenol. Also, nerve ablation can be used, which involves destroying the nerve with radiofrequency energy. This method will yield longer results, which gives the patient pain relief for up to six months.
Sphenopalatine Ganglion Block
The sphenopalatine ganglion (SPG) block is used to target the nerve bundle located behind the nose, called the sphenopalatine ganglion. These nerves are linked to the main nerve involved in headaches (trigeminal nerve). The SPG carries information to the brain about pain and sensation and blocking the SPG will reduce headache pain. The block involves the use of local anesthetics (lidocaine and bupivacaine), which are injected onto the nerves. SPG blocks are used to treat many types of headaches, include a migraine and trigeminal neuralgia.
SPG blocks are usually one by inserting a tiny plastic tube into the nose to deliver the medication to the nerves. The procedure is often done in around 15 minutes, and side effects include numbness of the throat, nausea, and foul taste in the mouth. This block will offer pain relief for several months. The pain management specialist may recommend several blocks done 2-3 weeks apart for maximum benefits.
Trigger Point Injections
Sometimes, treating the back portion of the neck will help relieve migraine headaches. Trigger points are areas in a muscle that is tight, irritable, and produce a twitch sensation when pressed. Deactivating these trigger points can relieve headache pain. Trigger point injections are done by inserting a tiny needle inside of the trigger point and injecting an anesthetic agent. The procedure is done in the office setting and can be repeated as necessary.
The medication will be injected into the muscle to block pain receptors within the nerves and reduce pain signals transmitted to the brain. When a steroid is used for trigger point injections, it can reduce inflammation and tissue swelling around nerves. The use of trigger point injections is a safe, effective procedure, with few side effects.