Novel Interventional Nonopioid Therapies in Headache Management

Abstract

Injection of botulinum toxin has been shown to increase the number of headache free days for patients suffering from chronic tension-type headaches. Suboccipital steroid injection has been demonstrated as a successful treatment option for patients suffering from cluster headache. Occipital nerve stimulation (ONS) has been described as a treatment for all types of trigeminal autonomic cephalgias. Percutaneous ONS is a minimally invasive and reversible approach to manage occipital neuralgia performed utilizing subcutaneous electrodes placed superficial to the cervical muscular fascia in the suboccipital area. Radiofrequency lesioning is another commonly used treatment in the management of chronic pain syndromes of the head and neck. If a diagnostic sphenopalatine ganglion block successfully resolves the patient's symptoms, neurolysis can be employed as a more permanent solution. Although many patients who suffer from headaches can be treated with conservative, less-invasive treatments, there still remains at present an ever-increasing need for those patients who are refractory to conservative measures and thus require interventional treatments. These procedures are continually evolving to become safer, more precise, and more readily available for clinicians to provide to their patients.

Care Among Migraine Patients in a Commercially Insured Population

“…Third, as our study relied on pharmacy claims for reporting medication use and identifying patients with migraine, these claims may not reflect actual use and do not account for over-the-counter medications. As such, patients may have filled their prescription and then pursued a non-pharmacological treatment and stopped their pharmacologic treatment [20,21]. Fourth, this study relied on available data in MarketScan, which may not reflect all of a patient's medical history; as such, some patients may actually be prevalent migraine patients and not newly diagnosed.…”

Localization of the Center of the Intramuscular Nerve Dense Region of the Suboccipital Muscles: An Anatomical Study

“…Botulinum toxin A (BTX-A) intramuscular injection to the motor endplate to block the release of acetylcholine from the presynaptic membrane and inhibit muscle excitation has been proven to be an effective method for the treatment of TTH caused by increased suboccipital muscle tension ( 16 , 19 – 21 ) and has become increasingly popular ( 22 – 24 ). However, the target location should be accurately identified for curative effects.…”