Occipital Nerve Blocks for Pediatric Posttraumatic Headache

Abstract

Posttraumatic headache is one of the most common and disabling symptoms after traumatic brain injury. However, evidence for treating posttraumatic headache is sparse, especially in the pediatric literature. This retrospective chart review evaluated the use of occipital nerve blocks in adolescents treated for posttraumatic headache following mild traumatic brain injury, presenting to the Complex Concussion and Traumatic Brain Injury clinic. Fifteen patients (mean age 15.47; range: 13-17) received occipital nerve block for posttraumatic headache. Follow-up was obtained in 14 patients at 5.57 (standard deviation = 3.52) months postinjury. The headache burden was high, with all except one having headaches 15 or more days per month (median 30, range 10-30). Sixty-four percent reported long-term response to the occipital nerve blocks, with associated improved quality of life and decreased postconcussion symptom scores (P < .05). One patient reported transient allopecia. Occipital nerve blocks are well tolerated and can be helpful in posttraumatic headache.

Patterns of Use of Peripheral Nerve Blocks and Trigger Point Injections for Pediatric Headache: Results of a Survey of the American Headache Society Pediatric and Adolescent Section

“…Respondents use nerve blocks for many different headache diagnoses. Consistent with the published pediatric case series, chronic migraine, new daily persistent headache, and post‐traumatic headache are among the most frequent indications for nerve block . The most common symptom prompting injection is local tenderness of the nerve.…”

“…Seeger reported a series of 15 children who had unilateral or bilateral GON block with lidocaine and corticosteroid (either triamcinolone or methylprednisolone) an average of 5.6 months after concussion. At follow‐up visit another 5.6 months later, 64% reported a reduction in headache frequency of at least 50% . Similarly, 2 case series reported benefit for at least 62% of pediatric patients with chronic migraine following unilateral injection in the region of the greater occipital nerve with a mixture of lidocaine and methylprednisolone .…”

“…The local anesthetics cause immediate numbness, though relief from pain can begin at the time of the injection or have a delayed onset of several days to 2 weeks following presumably due to changes in signaling in the involved networks. Duration of headache benefit can last from hours to weeks, extending well beyond the duration of nerve blockade . Local anesthetics are theorized to affect central pain modulation via the trigeminal nucleus caudalis, where the C2 afferents and trigeminal afferents co‐localize .…”

“…Typical of many therapies, nerve blocks have not been thoroughly tested in children with headache. Retrospective pediatric case series have described benefit from nerve blocks in chronic migraine, new daily persistent headache, and post‐traumatic headache . Though no controlled studies have been performed in children, nerve blocks are used because available clinical evidence suggests a low risk of side effects, and they have been used in children with other conditions for many years .…”

Post-Traumatic Headache Therapy in the Athlete

“…Following injection(s), 80 % reported having a Bgood^response and 20 % indicating Bpartialî mprovement of underlying pain. These findings have been echoed in more recent reports suggesting variable efficacy, including complete resolution of all concussion-related symptoms, another suggesting 64 % achieve long-term response to intervention, and lastly, one case of Bdramatic relief^after ultrasound-guided bilateral occipital nerve blocks [21][22][23]. Similarly, one retrospective study evaluated the safety and efficacy of concurrent trigeminal and occipital nerve blocks in PTH [24].…”