Do Occipital Nerve Blocks Help Migraine? 2023
Do Occipital Nerve Blocks Help Migraine?
Migraine is a trigeminal nerve/cerebral arterial problem with inflammation of the trigeminal nerve and the cerebral arteries. The migraine process produces the neurochemicals CGRP, neurokinin A, and Substance P which cause the inflammation.
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This is an article by Britt Talley Daniel MD, member of the American Academy of Neurology, the American Headache Society, migraine textbook author, and blogger.
There is a need for dependable, acute Migraine treatment for Migraine drug failure patients.
Occipital Nerve Block. Occipital Nerve Block has a long successful history of helping migraine patients. Steroids and/or local anesthetics are injected near the greater and lesser occipital nerves in the back of the head. The injection blocks pain signals and reduces swelling and inflammation in the back of the head and neck and is helpful for treating chronic headaches.
The nucleus caudalis in the brain stem is also activated by the migraine process and it’s fibers go to the back of the head on one side in the C2 distribution. C2 fibers go into the occipital nerve. Persons with chronic migraine which is defined as at least 15 headache days a month, eight of which have migraine features, commonly have pain in the back of their neck or head due to stimulation of the C2 fibers.
Persons with episodic migraine may have headache that starts in the back of the head or neck on one side and then comes forward to behind the eye or in the temple on the same side of the head.
Related questions.
Indications for the injection:
Occipital neuralgia
Migraine which hasn’t responded to conservative treatment
Post-lumbar puncture headache
Cluster headache
Cervicogenic headache
Where is the injection given?
The patient is conscious during the procedure. The doctor uses a 26 or 27 small gauge needle attached to a 5 cc syringe and injects in the back of the head at the level of the ears about halfway from the center on one side.
Specifically, the injection is given at points of the greater and lesser occipital nerves down to the periosteum of the occiput. The occipital nerve is between 8-18 mm deep.
The injection is usually given on the side of worst patient complaint of headache, but it will work if given on either side and it will also work for patients with pain on both sides of the back of their head.
The picture associated with this blog post shows where the injection is given.
What is injected?
The doctor injects cortisone for anti-inflammatory affect, such as methylprednisolone or triamcinolone and a long acting, local anesthetic such as lidocaine or bupivacaine. Studies have been done comparing clinical results using only a local anaesthetic alone and a local anaesthetic plus a cortisone drug and both injections seem to work equally well.
What about patient allergy to cortisone injection?
All patients should be queried regarding allergic reaction to cortisone drugs. Cortisone allergic patients should not be treated.
Where is this treatment performed?
The injection is usually given in an exam or treatment room in the doctor’s office. It is not a big deal and the side effects, which will be discussed later, are few and mild. Usually a small injection of one of the anaesthetic is given first and the doctor will wait about 5 minutes for the medicine to work and “numb” the spot where the full injection will later be given.
There is usually no blood loss and no need to use a band aid or dressing. The patient may sit up or lie down on side for the injection.
How long does the procedure take?
This is a simple, quick outpatient procedure, much like a dental injection of lidocaine during dental work, and just takes minutes.
How long before resumption of normal activities?
After the procedure the patient is not usually observed in the office and they ,may leave and have no problem driving themselves home and performing normal activities afterwards.
How long does the injection take?
The injection is usually very quick--15 minutes or so.
What are the results of Occipital nerve blocks?
A recent study found that 80% of patients experienced significant or moderate decrease in pain. Long term statistical studies are needed but the general experience in neurology and headache work is that these blocks are usually effective.
A second injection may be given to patients who respond well initially. This is usually done or offered several weeks after the first injection.
How long do the effects of nerve blocks last?
It is normal to have numbness at the local scalp injection site since local anaesthetics produce this. The numbness is like that which occurs with dental procedures. The duration of numbness is usually 3-4 hours.
Beneficial effect from the steroid takes 3-5 days. Pain reduction may last days to weeks, or occasionally several months.
What are the side effects of an Occipital nerve block?
The most common side effect is injection site pain which is short lived. Other side effects include temporary 6-8-hour symptoms of bleeding, dizziness, weakness, and light headedness. There is a slight risk of infection.
Summary
Cortisone and lidocaine injections in the Occipital nerve are easy, quick to perform, have a low side effect profile, and have a long history of successful treatment.
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Britt Talley Daniel MD