Earlier this year it was reported at the annual meeting of neurologists (The American Academy of Neurology) that treating migraine headaches with occipital nerve block was effective. Occipital nerve block is a procedure where anesthetic agents (lidocaine and bupivacaine) are injected near the occipital nerve on the back of the head near the base of the skull on the side of the migraine headache. Within five minutes after the nerve block, 60% of patients had mild or no headache and 75% of patients had mild or no light sensitivity (photophobia). Allodynia (pain caused by a stimulus that normally does not produce pain, such as brushing your hair) also reduced quickly after the nerve block. Over half of patients had no side effects. About 20% had pain at the injection site and about 20% experienced dizziness. The investigators of the study concluded that greater occipital nerve blocks are safe and easy procedures that can be performed in the office and show results more quickly than oral triptan medications.
Another recent study focused on occipital nerve blocks using anesthetic agents plus a steroid medication. There was no statistically significant additional benefit when steroids were added to the treatment.
The average duration of benefit in these trials was about four days. About 20% of responders still had total migraine headache relief one week after the injection.
Both of these trials were performed at the Thomas Jefferson University Hospital Headache Center in Philadelphia. With the small number of patients in both of these trials, it is difficult to know if these results would be noticed in a larger population. I suspect that occipital nerve block may be effective, but only in the short-term for migraine sufferers. This is not a preventive treatment for migraine headaches. If an individual has true occipital neuralgia due to pinching or entrapment of the occipital nerve, then occipital nerve block may be of long-term benefit.
It seems that the practicality of this treatment is also questionable. Many neurologists have not been trained in how to perform occipital nerve blocks. Also, if the patient responds to triptan medications or other oral "abortive" medications, then occipital nerve block may not be reasonable. This type of treatment is more expensive than just taking a pill, although it is probably cheaper than going to the emergency room for treatment of a severe migraine. And if your migraine occurs at night or on the weekend, the likelihood of you finding your neurologist to perform this injection is probably quite low.
If a medication is developed that could be injected in the occipital nerve region to provide a long-term reduction in the patient's migraine frequency, then this treatment would likely become standard of care.
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Another recent study focused on occipital nerve blocks using anesthetic agents plus a steroid medication. There was no statistically significant additional benefit when steroids were added to the treatment.
The average duration of benefit in these trials was about four days. About 20% of responders still had total migraine headache relief one week after the injection.
Both of these trials were performed at the Thomas Jefferson University Hospital Headache Center in Philadelphia. With the small number of patients in both of these trials, it is difficult to know if these results would be noticed in a larger population. I suspect that occipital nerve block may be effective, but only in the short-term for migraine sufferers. This is not a preventive treatment for migraine headaches. If an individual has true occipital neuralgia due to pinching or entrapment of the occipital nerve, then occipital nerve block may be of long-term benefit.
It seems that the practicality of this treatment is also questionable. Many neurologists have not been trained in how to perform occipital nerve blocks. Also, if the patient responds to triptan medications or other oral "abortive" medications, then occipital nerve block may not be reasonable. This type of treatment is more expensive than just taking a pill, although it is probably cheaper than going to the emergency room for treatment of a severe migraine. And if your migraine occurs at night or on the weekend, the likelihood of you finding your neurologist to perform this injection is probably quite low.
If a medication is developed that could be injected in the occipital nerve region to provide a long-term reduction in the patient's migraine frequency, then this treatment would likely become standard of care.
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