Earlier I wrote about Nerve blocks controlling headaches.
Quick Fix For Headaches – Repeated Nerve Supraorbital, Infraorbital, and Occipital Nerve Blocks – and What To Do For The Very Bad
Several protocols had been made up. This present one, was weekly Occipital Nerve Blocks either unilateral or bilateral for one month and then monthly thereafter. After 3 months, headache frequency was cut about in 1/2, and the headaches were some shorter and a bit less severe. This is a good or better than botulinum but if used in combo should give great results.
Neurol Sci. 2017 Feb 28. doi: 10.1007/s10072-017-2861-5. [Epub ahead of print]
Do bilateral and unilateral greater occipital nerve block effectiveness differ in
chronic migraine patients?
- 42 patients with an average of 20 migraines/month
Comment – I use 5% lidocaine as its use has been documented before and is easy to use as long as you stay at 2 ml for average adult and 1.5 mls for elderly.
J Headache Pain. 2010 Dec;11(6):519-23. doi: 10.1007/s10194-010-0244-x.
Adverse effect profile of lidocaine injections for occipital nerve block in occipital neuralgia.
Sahai-Srivastava S et al
I put about 0.5 mls into each tender location:
– 3rd occipital nerve near midline – Greater Occipital nerve maybe 2.5 cm laterally
– Lesser Occipial nerve – half way out from there to ear
make sure you bend needle 30 degrees and try to run parallel into nerve. I use a 30 gauge needle unless heavyset. Don’t try injecting steroid through a 30 gauge though…
Steroids are unnecessary unless they have had a constant headache for days (A status migraine) in which case 40 ml triamcinolone IM helps. In study below they compared results to injecting steroids – only got 6 days relief from steroids.
There is a way to augment the semi-neurolytic effects of lidocaine by using 10% lidocaine but then you are reduced to 1 ml.which is enough to do 2 spots:
J Pain Res. 2016 Sep 29;9:721-725. eCollection 2016.
Prolongation of greater occipital neural blockade with 10% lidocaine neurolysis:
a case series of a new technique.
Kim DD et al
- They got relief for 148.05 +/- 98.87 days which sounds appealing.
- Would be hard to do much with elderly if stuck to 0.75 mls of 10% at a time – have done it though, by having patient come back in a few hours to have second spot done…
If subject is desperate:
- triamcinolone depot 40 – 60 mg IM if unremitting
- ketamine protocol daily until headache broken
Simulating Ketamine Infusions with Repeated Detoid Muscle Injections
- Occipital and perhaps supraorbital blocks repeatedly
- Botulinum toxin protocol
Chronic Migraines – Botulinum Helps