Headache Disorders and Nerve Blocks Quiz

Practical Guide for Administering Peripheral Nerve Blocks in Headache Medicine

• Headache is a common neurological referral and a frequent cause for acute hospital admissions.

• Peripheral nerve blocks are widely used in headache and pain services to treat patients with headache disorders.

• There is no readily accessible resource with instructions for the delivery of peripheral nerve blocks.

• The authors provide a practical approach for administering peripheral nerve blocks and cover the current evidence base for such procedures in different headache disorders.

• The guide includes instructions and an audiovisual guide for administering greater and lesser occipital, supratrochlear, supraorbital, and auriculotemporal nerve blocks.

• The evidence base for the effectiveness of peripheral nerve blocks for managing different headache disorders varies depending on the pericranial nerve targeted and the outcome measure used.

• Peripheral nerve blocks have been effective in managing acute or prolonged migrainous episodes that commonly present to the emergency department.

• Knowledge of the anatomical landmarks of the occipital and superficial branches of the trigeminal nerve is important for effective nerve blockade, and to avoid possible complications such as nerve trauma, bleeding, or inadvertent arterial injection of anesthetic drug.

• The guide provides general considerations and instructions for administering greater occipital nerve blocks, including injection technique and recommended injection volume.

• The constituents of the nerve block differ with the cranial nerve injected and between headache centers.

• Corticosteroids are commonly used only for greater occipital nerve blocks, but some headache centers use them to infiltrate the lesser occipital nerve as well.

• Consensus recommendations by the American Headache Society and the Spanish Headache Study Group have used the evidence base to provide guidance on the administration of peripheral nerve blocks for different headache disorders.Peripheral Nerve Blocks for Headache Disorders: Tips for Safe and Effective Administration

• Peripheral nerve blocks are effective in the acute and preventative management of several headache disorders, including acute and chronic migraines, cluster headaches, and painful cranial neuralgias.

• Patient position and anatomical landmarks are key for the successful delivery of peripheral nerve blocks.

• Corticosteroids are frequently used for greater occipital nerve blocks and may also be used for lesser occipital nerve blocks.

• Supraorbital, supratrochlear, and auriculotemporal nerve blocks involve a combination of lidocaine and/or bupivacaine.

• Uncommon but important adverse effects of peripheral nerve blocks include transient dizziness, light-headedness, transient headache exacerbation, and rarely, localised lipoatrophy and alopecia with corticosteroids.

• Allergy to local anaesthetic or corticosteroid is a potential pitfall, and patients should be asked about previous reactions to local anaesthetic or allergies.

• Bleeding is usually minimal, and applying pressure with a swab after the injection will suffice.

• Pre-existing bleeding disorders and anticoagulation use are relative contraindications and decisions about injecting these patients should be individualised depending on the benefits and risks.

• Patients have occasionally reported transient light-headedness and dizziness post-procedure, which settles after a few hours.

• Corticosteroid nerve blocks are not recommended during pregnancy, while anaesthetic-only blocks are considered safe and recommended throughout pregnancy.

• The supraorbital nerve is located just above the supraorbital notch and can be targeted with a 1.0 or a 2.5 mL syringe with a 30-gauge needle.

• The auriculotemporal nerve is located superficially just anterior to the tragus and can be targeted with a 5 mL syringe with a 30-gauge needle.Peripheral Nerve Blocks for Headache Disorders: A Review of Clinical Studies and Recommendations

• Peripheral nerve blocks, including occipital nerve blocks, are a treatment option for headache disorders.

• Clinical studies have shown the efficacy of peripheral nerve blocks in treating a variety of headache disorders, including migraines, cluster headaches, and occipital neuralgia.

• Greater occipital nerve blocks have been found to be effective in treating acute migraines and prolonged or persistent migraine aura.

• Multiple cranial nerve blocks have shown promise as an alternative preventative therapy for chronic migraines.

• Suboccipital steroid injections have been found to be effective in treating patients with more than two cluster headache attacks per day.

• Peripheral nerve blocks have been found to be safe in pregnant women with migraines.

• Adverse effects of peripheral nerve blocks may include Cushing syndrome, cutaneous atrophy, alopecia, and pain at the injection site.

• Expert consensus recommendations exist for the performance of peripheral nerve blocks for headaches, including the use of ultrasound guidance and the importance of patient selection and informed consent.

• Anatomical analysis of the distribution patterns of occipital cutaneous nerves has been conducted to improve the accuracy and efficacy of occipital nerve blocks.

• Lidocaine injections for occipital nerve blocks have been associated with adverse effects in some patients with occipital neuralgia.

• Peripheral nerve blocks are a valuable treatment option for headache disorders, but should be used in conjunction with other therapies and under the guidance of a headache specialist.

• Further research is needed to better understand the mechanisms of action and long-term efficacy of peripheral nerve blocks in treating headache disorders.