Nerve Blocks for certain types of Migraines, Occipital Neuralgia

The best candidates for greater occipital nerve block are those patients with one-sided pain that occurs predominately at the back of the head. Patients with the “nerve-like” shooting, zapping, stinging, or burning pain of occipital neuralgia generally respond best. There has been some degree of temporary success for patient with migraines, cluster headaches, and a variety of other painful conditions, particularly when the scalp becomes tender, which may indicate that the nerve is inflamed.

Treatment for migraines usually follows this sequence, from least invasive in a stepwise manner.
· Starting with over the counter pain medications like Tylenol or Advil type medications and some prescription medications can be added.
· Adding some other techniques such as rest, Massage, TENS type units, Chiropractor Care and Physical Therapy, or even Botox
· Once most of these methods have been tried and unsuccessful, a greater occipital nerve block can be tried.
block can be tried.

If you suffer from migraines, we at Pain Specialists of Brighton most health insurance and are booking consultations today to help you find your path to migraine relief.

In its simplest form, It is an injection of medication into the back of your head near specific nerves to try and place steroid as close to the site of inflammation/irritation as possible. The steps are as follows:
· When you first arrive at the office your information is reviewed and updated as needed
· We go over the procedure and allow time for any questions that may come up to be answered
· We go over the risks and benefits and have you sign a written consent.
· This procedure is done under ultrasound, you are typically placed face down on the procedure table
· We will clean the back of your head and then do a “timeout” to again confirm that we are treating the right patient and area of the patient, that we know what your allergies are, we confirm if you are a diabetic, if you are on blood thinners or if you are pregnant
· We will then use the ultrasound in a sterile sleeve to visualize the greater and lesser occipital nerves.
· We will spray your skin with some cold spray to anesthetize your skin and then we will place some numbing medication just under your skin.
· We will then guide the needle under real time ultrasound guidance right to the space that we need to inject the medication
· After confirming that we are not in a blood vessel, we will injection the medication and remove the needle and dress the site.
· We will get the patient up and then observe them for about thirty minutes, re-evaluate and see where their pain level is, and then once all is good, discharge home with verbal as well as written instructions.

· First it works due to the local anesthetic that is injected that actually numbs the tissues, this is often short lived. Also, sometimes there can actually be adhesions that kind of bind the nerve and muscle together causing an “entrapment” of the nerve. This injection can actually break up some of that entrapment helping to eliminate a potential cause of the pain by removing the adhesion allowing more free movement between the nerve and muscle.
· Secondarily, the act of putting fluid in the space acts by diluting, or washing out the inflammatory mediators that cause the nerve to be irritated and inflamed
· Third, it works due to the natural action of anti-inflammation from the steroid medication. This action does take several days to a week sometimes to manifest itself

· Similar to epidural, the numbing medication works right away and people tend to get a great amount of relief right away.
· As the numbing medications wear off the pain may come back or even be more irritated.
· After about a week the steroid will really start kicking in and the pain relief tends to be long lasting after that.

The results typically last for months or longer. Sometimes it is necessary to repeat the injection, often with repeat injections providing better, longer lasting relief. It is important to note, sometimes patients do not get relief, which is actually helpful in that it enables us to rule out certain causing of your pain.

If you suffer from migraines, we at Pain Specialists of Brighton most health insurance and are booking consultations today to help you find your path to migraine relief.