Narrative review of peripheral nerve blocks for the management of headache

Abstract

Objective: To provide an overview of the current available literature on peripheral nerve blocks for the management of migraine and other headache disorders in adults.Background: Peripheral nerve blocks have been commonly performed in the headache practice for migraine, cluster headache, occipital neuralgia, and other headache disorders, despite a paucity of evidence supporting their use historically. In the past decade, there has been an effort to explore the efficacy and safety of peripheral nerve blocks for the management of headache, with the greatest interest centered around greater occipital blocks. Design:We performed a search in PubMed using key words including "occipital nerve blocks," "peripheral nerve blocks," "occipital nerve," "migraine," "cluster headache," and "neuralgia." We reviewed the randomized controlled trials (RCTs), observational studies, and case series, and summarized the anatomy, techniques, and the evidence for the use of peripheral nerve blocks in different headache disorders, with particular focus on available RCTs. Case reports were included for a detail review of adverse events.Results: Of 12 RCTs examining the use of greater occipital nerve blocks for migraine, all but one demonstrate efficacy with reduction in headache frequency, intensity, and/or duration compared to placebo. Studies have not demonstrated a difference in clinical outcomes with the use of corticosteroids for nerve blocks compared to blocks with local anesthetic in the treatment of migraine. There are two RCTs supporting the use of greater occipital blockade for cluster headache, both showing benefit of suboccipitally injected corticosteroid. One RCT suggests benefit of greater occipital nerve blocks for cervicogenic headache. Observational studies and case series/reports show that greater occipital nerve block may be effective in prolonged migraine aura, status migrainosus, post-dural puncture headache, and occipital neuralgia. Overall, peripheral nerve blocks are well tolerated. Serious side effects are rare but have been reported, including acute cerebellar syndrome and infection.Conclusions: Peripheral nerve blocks, especially occipital nerve blocks, are a viable treatment option for migraine and may be helpful in cluster headache as a transitional therapy or rescue therapy.

One Patient, Three Providers: A Multidisciplinary Approach to Managing Common Neuropsychiatric Cases

“…Peripheral nerve blockade, primarily targeting the greater occipital nerve, is widely used, effective, and well tolerated in both acute and preventive migraine management [16]. However, as there is no consensus yet regarding the technique, dosage, and application interval, further prospective studies are needed.…”

Ultrasound-Guided Combined Greater Occipital Nerve Block at the C2 Level with Trapezius Trigger Point Injection and Supraorbital-Supratrochlear Nerve Block: More Effective on Allodynia and Disability in Chronic Migraine

“…[ 25 ] With 1–5 mL of 0.5% bupivacaine administered to each block, the same blocks on the same side were repeated in the other weeks. [ 6 ] The instructions are detailed below. Follow-up assessments were conducted in the first and third months using the brush allodynia test and surveys.…”

“…[ 5 ] Trigger point injections (TPIs), supraorbital and supratrochlear nerve blocks (SONB, STNB), and greater occipital nerve block (GONB), which are all effective migraine treatments, can be used when medical therapy fails. [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ] Myofascial discomfort can cause or contribute to headache syndromes by generating trigger points, which are areas of concentrated allodynia. The trapezius muscle, the most typical headache trigger point location, can induce pain in the temporal, jaw, occiput, and upper neck regions.…”

Migraine treatment with GON blockade at the level of C2: The tip of the iceberg and the submerged portion

“…For this reason, preventive treatments involving peripheral nerve blocks have been widely used recently 1 . The most commonly used peripheral nerve block technique in the treatment of migraine is the blocking of the greater occipital nerve (GON) 2 . The effect of GON block is observable in the trigeminovascular system, which plays a vital role in the pathophysiology of migraine [3][4][5] .…”