Peripheral Nerve Blocks and Trigger Point Injections in Headache Management – A Systematic Review and Suggestions for Future Research

Abstract

Interventional procedures such as peripheral nerve blocks (PNBs) and trigger point injections (TPIs) have long been used in the treatment of various headache disorders. There are, however, little data on their efficacy for the treatment of specific headache syndromes. Moreover, there is no widely accepted agreement among headache specialists as to the optimal technique of injection, type, and doses of the local anesthetics used, and injection regimens. The role of corticosteroids in this setting is also debated. We performed a PubMed search of the literature to find studies on PNBs and TPIs for headache treatment. We classified the abstracted studies based on the procedure performed and the treated condition. We found few controlled studies on the efficacy of PNBs for headaches, and virtually none on the use of TPIs for this indication. The most widely examined procedure in this setting was greater occipital nerve block, with the majority of studies being small and non-controlled. The techniques, as well as the type and doses of local anesthetics used for nerve blockade, varied greatly among studies. The specific conditions treated also varied, and included both primary (eg, migraine, cluster headache) and secondary (eg, cervicogenic, posttraumatic) headache disorders. Trigeminal (eg, supraorbital) nerve blocks were used in few studies. Results were generally positive, but should be taken with reservation given the methodological limitations of the available studies. The procedures were generally well tolerated. Evidently, there is a need to perform more rigorous clinical trials to clarify the role of PNBs and TPIs in the management of various headache disorders, and to aim at standardizing the techniques used for the various procedures in this setting.

Efficacy of Local Lidocaine Application on Anxiety and Depression and Its Curative Effect on Patients with Chronic Tension-Type Headache

“…They reported that both groups of patients benefited from these applications without any significant difference between the types of procedure. Ashkenazi et al [28] injected local anesthetics on myofascial trigger points and greater occipital nerve in 37 patients who suffered from chronic headaches every day, and reported major improvements in complaints of the patients within 20 min. …”

Greater Occipital Nerve Block for Acute Treatment of Migraine Headache: A Large Retrospective Cohort Study

“…Some studies looked at the efficacy of GON block in the treatment of other headache syndromes, including cluster headache, chronic daily headache, and cervicogenic headache, along with separate pathologies including trigeminal neuralgia and post-dural puncture headache. 27 The first double-blind, randomized controlled trial was performed by Piovesan et al 16 in 2001; they included 37 patients and compared GON block to placebo as preventive management of migraine, and in a crossover design performed a sham procedure or GON block. Although they found no difference in the number or duration of migraine episodes between the procedures, the group that received GON block experienced a significant reduction in migraine intensity during the 60-day follow-up period.…”

Occipital Neuralgia as a Sequela of Sports Concussion

“…This blockade will provide rapid pain relief and can be used as a diagnostic guide for future therapies. While local anesthetic blockade pharmacologically is short-lived, pain relief may be of much longer duration (as was with the presented cases); however this dissociation between the duration of pharmacological effect and the duration of symptomatic relief is not well understood (1). …”