C2 Dorsal Root Ganglion
The Dorsal Root Ganglion is the sensory part of the spinal nerve. This nerve can be irritated by Craniocervical Instability, a bone spur in the upper neck bones, or arthritis in the C1-C2 facet joint. The headache will be in the back of the head and this nerve requires a careful and precise injection of numbing medicine using x-ray guidance and should only be performed by those physicians experienced in upper cervical injections.
Common Uses For Nerve Blocks
Nerve blocks are often used during surgeries to ease pain. They may also be used to manage the pain of chronic health conditions or injuries in which the nerves are damaged, inflamed, or irritated.
Nerve blocks are commonly used to manage pain that comes from the spine, as well as debilitating pain that affects the arms, legs, neck, and buttocks.
You and your healthcare provider may discuss a nerve block to manage these types of pain:
Labor and delivery pain
Severe facial pain, like trigeminal neuralgia
Low back pain
Headaches, including migraines and occipital neuralgia
Chronic regional pain syndrome, or CRPS
How Often Is A Proper Headache Work
ALMOST NEVER! I have yet to see a patient walk in my office, no matter what famous Medical Center they have been to or which famous department head they saw, get a complete diagnostic work-up for all of the things that can cause headache. What usually happens is that they see a Neurologist who performs a few simple, blind in-office nerve blocks and when that doesnt help, the work-up is considered complete. As youll see below, a proper diagnostic block work-up is MUCH MORE COMPLEX than what the neurologist considered.
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Injection Therapy For Migraines In Santa Barbra Ca
There are a few options for injection therapy for migraine headaches, though the principal two techniques utilize Botox or local anesthesia . In 2010 the FDA approved the use of Botox injection to prevent headaches in chronic migraine patients, and in these patients, Botox is often given as multiple injections around the neck and head. The recommended dosing distributes 155 units of Botox divided into 31 different sites, and Botox is routinely successfully used by neurologists and pain control physicians.
When performed by Dr. Lowenstein, these injections are done differently. Dr. Lowenstein performs diagnostic nerve blocks in patients who present to the office with headache pain. These injections provide temporary relief but allow Dr. Lowenstein to pinpoint the cause of the patients headache pain, and show us that these patients are good candidates for migraine surgery. If you have a headache when you come to see Dr. Lowenstein, the nerve block is performed with local anesthesia. This injection with Lidocaine and Marcaine can produce immediate though temporary results, indicating that you would be a great candidate for migraine headache surgery.
New Nerve Block Procedure Effectively Treats Migraines
The SphenoCath, opens new tab procedure for establishing a sphenopalatine ganglion nerve block, opens new tab can provide rapid and significant pain relief to patients who present with intractable migraines that are refractory to prescribed therapies. The minimally invasive, in-clinic procedure is performed by many of the neurologists at Meritas Health Neurology, opens new tab, including Cynthia J. Ward, DO, opens new tab, Steven C. Kosa, MD, opens new tab and Larry C. Hollenbeck, MD, opens new tab. It is an urgent treatment option offered for migraine relief and to help patients avoid an Emergency Department visit.
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What Is Greater Occipital Nerve Block
A Greater Occipital Nerve block is an injection which contains small dose of local anaesthetic and/or steroid which is injected around the greater occipital nerve. The injections may be given on one side, or on both.
The greater occipital nerves travel up each side of the back of the head. People who often have headaches may find this nerve is oversensitive. The GON block aims to help by reducing the level of pain for a period of time.
What Side Effects Might I Get
It is common to experience a lump at the injection site with an accompanying bruised sensation for a few or several days. About one in 30 patients experience transient worsening of their head pain. In theory, infection of the injection site could occur. Very rarely, patients can faint with injections: these patients should be lying down to have injections. Some people can experience temporary hair-loss at the site of injection.
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What To Know About Occipital Nerve Block
Medical News Today
The occipital nerve runs from the base of the skull along the back of the head. An occipital nerve block is a procedure to temporarily provide relief from pain related to this nerve, such as that due to certain headache types.
The occipital nerve has three branches. They include:
- the greater occipital nerve
- the lesser occipital nerve
- the third occipital nerve
During an occipital nerve block, doctors typically use medication to block the GON. There are several ways they can do this.
In this article, we discuss an occipital nerve block. We also look at the potential side effects and benefits of receiving one.
What is an occipital nerve block?
An occipital nerve block is a solution that a doctor injects into the area surrounding the occipital nerve. According to the American Migraine Foundation, the solution can vary but will typically contain a mixture of an anesthetic and a steroid anti-inflammatory drug.
The goal of an occipital nerve block is to relieve pain and allow the person to return to normal activities. The steroids in the block may help reduce localized inflammation and may help prevent it from returning.
In a small 2018 study researchers noted that the procedure is simple, safe, and people generally tolerate it well. However, they also state that a person should try other treatment and management techniques before having the block.
What to expect during the procedure
One way a doctor may perform the block is as follows:
- cervicogenic headache
How Does Nerve Decompression Surgery Help With Migraines
Because the injection into the nerve is painful, nerve blocks are performed under anesthesia. Occipital Neuralgia. As with nerve decompression surgery, the same surgery that benefits migraine sufferers can help with the pain of occipital neuralgia. Neuro-stimulators are embedded at the base of the head and block pain messages to the brain.
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How To Get It
If a person has recurring migraine headaches they should speak to a healthcare professional. After carrying out a medical evaluation, the medical professional may suggest a nerve block as a possible treatment for the migraine headaches.
The nerve block could reduce the severity of any migraine headaches, reduce their frequency, or stop them altogether.
Clinical Presentation And Diagnosis
The predominant areas of pain presentation with cervicogenic headache are the forehead, the periorbital areas, the vertex of the skull, the temples and the occiput area . A discussion of the pathogenesis and pathophysiology is beyond the scope of this article but may be found in various neurology and headache texts.
Figure 2.Needle position for lesser occipital block Figure 3.Needle position for greater occipital block
An effective method of detecting occipital neuralgia or cervicogenic headache caused by hyperalgesia of the occipital nerve is to palpate the branches at their superficial distribution near the superior nuchal line and the mastoid notch area. The greater branch will become superficial approximately 2 cm lateral to the bony protuberance near the midline at the superior nuchal line. The lesser distribution becomes superficial near the mastoid notch. Four to five grams of pressure in these areas will produce anything from tenderness to sharp shooting pain at these distribution sites if the nerve is in a state of hyperactivity.
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Sphenopalatine Ganglion Blocks In Headache Disorders
The Sphenopalatine Ganglion is a group of nerve cells that is linked to the trigeminal nerve, the main nerve involved in headache.
The SPG, located behind the nose, carries information about sensation, including pain, and also plays a role in autonomic functions, such as tearing and nasal congestion.
To read more about the SPG and its role in headache, please see this article:
The link between the SPG and the trigeminal nerve is important in head pain. If you apply local anesthetics to block or partially block the SPG, this can be helpful in reducing head and facial pain.
SPG blocks were first described in the 1900s using a technique involving the application of numbing medication onto cotton swabs then placed into the back of the nose. Another technique used to block the SPG involves using a needle to inject the SPG through an area on the cheek. This process is invasive, and usually requires the use of an x-ray machine to place the injection correctly.
There are FDA cleared, commercially available catheters that your doctor may use. These devices involve placing a very thin plastic tube into the nose to insert numbing medication in and around the SPG. These devices, called catheters, may be more effective in reducing head and facial pain than the technique using cotton swabs and are less invasive than the injection technique.
How Many Do I Need To Have
As many as you need, to fix your pain!
Exceptionally the injection can be repeated after a month if benefit is good but transient at that time. Other wise, it can be repeated as often as every two months. If the injections need to be repeated every two months for a year then it may be better to consider another treatment.
Not all treatments work the same every time if you have two successive greater occipital nerve blocks with insufficient benefit, its probably best to try a different treatment.
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Research Into Occipital Nerve Blocks
Occipital nerve blocks are often recommended to patients who have moderate to severe headache pain that has not responded to traditional medical management, such as oral analgesics.
Multiple studies have shown that occipital nerve blocks are successful in treating patients with occipital neuralgia, cervicogenic headache, and cluster headache. Additionally, there is some evidence to suggest that this procedure may be beneficial for the treatment of migraine. Furthermore, occipital nerve blocks may play an important role in rescue treatment, and in the treatment of medication over-use headache however, further research is needed to confirm this finding.
Preliminary studies suggest that occipital nerve blocks are not an appropriate treatment for tension headache, hemicranias continua, and chronic paroxysmal hemicranias however, its use in these cases is not completely excluded.
Occipital neuralgia is a neurological condition that arises due to dysfunction or damage of the occipital nerves. The symptoms of occipital neuralgia are often confused with migraine or other types of headache syndromes however, occipital neuralgia is a distinct condition that requires an accurate diagnosis for successful management.
Symptoms of occipital neuralgia include intense pain that can be sharp or jabbing, and can feel like an electrical shock in the back of the head as well as the neck. Other symptoms experienced by patients with occipital neuralgia include:
Preparing For A Nerve Block
There are no special preparations needed for a nerve block. You can eat and drink normally beforehand. Dont take any anti-inflammatory medicines, such as ibuprofen or naproxen, within 24 hours of your nerve block procedure. If you take blood thinners such as aspirin , heparin, or warfarin , inform your doctor before scheduling a nerve block.
If youre having a nerve block for a surgery, your doctor might have some specific instructions for you to follow prior to your surgery, especially if several types of anesthetic are going to be used. This might include not eating or drinking anything for 6 to 12 hours prior to your surgery. Be sure to confirm these instructions with your doctor ahead of your surgery day.
Make sure you have someone available to take you home after the procedure. People whove had a nerve block shouldnt drive themselves home.
In general, the procedure for a nerve block involves these steps:
The entire procedure will likely take less than 30 minutes.
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Will Insurance Cover This Procedure
Some insurances may cover SPG block for a variety of headache disorders, but you should speak with your insurance representative to ensure it is covered if your provider performs it.
SPG block, using one of these three catheters, is a safe, quick, and effective way to reduce the severity and frequency of various headache disorders for a period of time. Like many other procedures in headache medicine, SPG block is likely to work best when combined with a comprehensive headache treatment plan.
Larry Charleston IV, MD, FAHSHeadache Medicine
What To Expect During The Procedure
During the procedure, youll lie face down on the table.
A medical professional will apply an anesthetic to the back of your head just above your neck. Theyll then insert a fine needle into the injection site until the needle reaches your occipital nerve.
After the injection, the area will become numb as the pain-relieving medication takes effect. Some people notice improvements in their pain in as little as 15 minutes.
The procedure only takes a couple of minutes to complete. You should arrange to have someone drive you home after the procedure, but youll typically be able to drive and return to normal activities the next day.
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Everyone Responds Differently To A Nerve Block
For some people, a nerve block gives immediate relief. For others, it takes a series of injections before it helps ease the pain. Its very unpredictable because pain is a personal perception and everyone responds differently, Dr. Shin says.
Also, if you have had chronic pain for 10 or more years, it could involve multiple pain generators. There are many anatomic structures and the pain could come from more than one joint or nerve.
In the spine, its possible that your first injection may be diagnostic. Based on the response of the injection, further injections, a different approach or different levels can be performed. Ultimately, the goal is to identify the source of pain, to improve function and avoid surgery.
This also means that the sooner you can get an injection before your pain becomes chronic, the better your result. And injections are typically combined with other forms of treatment such as physical therapy to increase your chances of getting better.
Occipital Nerve Block For Cervicogenic Headaches
Headache is one of the most common complaints received in the primary care practice setting. It is estimated that 5% of the population will seek care for head pain in a given year.1 These patients may present a practitioner with some of his greatest challenges but can also produce some of the greatest rewards when treated successfully.
One percent of headaches are attributed to disorders of the neck.2 According to IHS2 guidelines, these headaches are defined as cervicogenic.3 To fulfill IHS guidelines the following diagnostic criteria must be met:
Figure 1.Typical pain presentations with cervicogenic headache.
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Other Types Of Injections Performed By Physicians Or Physiotherapists
Trigger point injections are usually used to relax tense muscles. The product injected can be saline or lidocaine. The target are «taut bands» that can be palpated by expert clinicians.
Dry needling also targets tense muscles, but no product is injected. The needle itself is moved to bring the muscle to release. These injections can be quite painful.
A few comments on blocks
- Every procedure may trigger a placebo response. An improvement after an injection does not confirm beyond a doubt that the source of the pain is the injected site, but it may suggest it.
- Every procedure carries a risk of bleeding, infection, and injury to the nearby structures. Discuss this with your physician before giving consent. Blocks have less side effects on the body and brain than oral medications.
- Procedures require expertise. Results may vary from a provider to the other and depends on the technique. Trying a different provider sometimes leads to different results.
- The evidence supporting the use of blocks for headaches is not very strong. Studies are not easy to complete, and comparison to placebo is a challenge. Nevertheless, many headache experts do use blocks on a «try and see» basis, as positive results have been observed.
- Occipital blocks with steroids are proven effective for cluster headache and should be offered for this disease. See this post
Are There Any Side Effects
Generally, GON blocks are well tolerated. There is a small chance of bleeding or bruising at the injection site. Some people also report dizziness afterwards, which is why youre asked to wait for a little while after the injection.
Some people find their migraine feels worse for a few days after the injection. This is normal and should settle down. Continue to take you regular treatments. If it continues or you are concerned by any side effects contact your doctor.
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