<p>Relief of Secondary Headaches with High Thoracic Erector Spinae Plane Block</p>

Abstract

Intractable headaches can be debilitating, often leading to significant distress, prolonged medical treatment, and unanticipated hospital admissions. There have been significant advances in the treatment of primary intractable headaches such as migraines, tension headaches, and cluster headaches beyond medical management. Treatments may now include interventional strategies such as trigger-point injections, peripheral nerve stimulators, or peripheral nerve and ganglion blocks. There are few studies, however, describing the use of interventional techniques for the management of intractable secondary headaches, including those attributed to injury or infection. A new regional anesthetic technique, the erector spinae plane (ESP) block, was initially used for neuropathic thoracic pain. ESP block has since been reported to provide acute and chronic pain relief of the shoulder, spine, abdomen, pelvis, thorax, and lower extremity. Additionally, there has been one case report to describe the use of the ESP block in the treatment of refractory tension headache. We report four cases of effective analgesia for intractable secondary headache resistant to medical management with high thoracic ESP blocks. In each case, the ESP block provided instant pain relief. We suggest that the findings of this case series indicate that the ESP block may be a useful intervention in patients with severe secondary headache or posterior cervical pain where conventional therapies have limited success, though more studies are necessary.

The “new kid” on the fascial plane block: erector spinae block – a narrative review

“…Cervical level dermatomal distribution may be targeted indirectly, as reported by several cases of ESP block insertions between levels T2-T5, demonstrating effective analgesia for shoulder and proximal humerus procedures. 10,11,24 ESP blocks at T4 demonstrated diaphragm sparing blockade for upper limb surgery. 24 The analgesic efficacy of lumbar ESP blocks for hip and proximal femur surgery is comparable to quadratus lumborum blocks (QLB).…”

“…25 Further investigations may be necessary before the ESP block is regarded as a reliable alternative compared to older, well-described regional techniques for orthopaedic limb procedures. 10,11,[24][25][26] Advantages of ESP blocks: why should it be used?…”

“…Although inserted at T4, the proposed target was anaesthetic spread to cervical spinal levels, specifically the trigeminocervical complex, which is implicated in the pathophysiology of PDPH 9. Similarly, Hernandez et al10 demonstrated the treatment of both primary and secondary headaches with bilateral T4 ESP blocks.…”