Peripheral nerve blocks for an acute migraine

Peripheral nerve blocks can be very effective in stopping a severe migraine attack. We utilize them when a patient does not respond to oral or injected medications or when medications are contraindicated because of a coexisting disease or pregnancy.

Dr. Jessica Ailani and her colleagues at the Georgetown University in Washington, D.C. presented their experience with nerve blocks at the last annual meeting of the American Headache Society in Los Angeles. The study included 164 patients. Most patients received occipital and trigeminal nerve blocks using lidocaine or a similar local anesthetic.

Most patients were satisfied with the results, which lasted from several days up to 2 weeks. Only a small number of participants experienced side effects such as soreness at the site of injections, nausea and vomiting, and head and neck pain.

Dr. Ailani noted that more than 71% of patients rated their pain as 4 to 8 out of 10 before treatment with a nerve block. After a nerve block, nearly half (47.2%) said the pain had reduced to 1 out of 10.

“This is a very well-tolerated procedure and patients are very satisfied with the procedure,” said Dr. Ailani.

Nerve blocks can help keeps headache sufferers out of the emergency room and provide an alternative to systemic drugs, that is drugs that are injected or ingested. Systemic drugs affect the entire body while nerve blocks exert only local effects (unless one is allergic to local anesthetics).

Dr. Robert Kaniecki, a headache specialist in Pittsburgh uses nerve blocks for the prevention of chronic migraine headaches. He administers them into the same areas where Botox is injected. He finds that for some of his patients nerve blocks given every 12 weeks can be as effective as Botox. It is possible that such patients have milder migraines since the effect of nerve blocks lasts a very short time (lidocaine leaves the body after 4 hours or so) compared with the effect of Botox which lasts 3 months. Unlike Botox injections, nerve blocks have not been subjected to a rigorous scientific study comparing them to placebo (saline) injections.

  1. Jack Wehr says: 02/13/20178:31 pm

    Thank you for your feedback, Doctor.

  2. Dr. Mauskop says: 02/13/20173:22 pm

    You are right – it is too good to be true and there are no large controlled studies to prove its efficacy, only anecdotal reports by Dr. Reed. It is possible that stimulating occipital and supraorbital nerves does provide relief beyond the placebo effect, but considering that this is an expensive and invasive procedure, I would not recommend it.

  3. Jack Wehr says: 02/13/20173:05 pm

    Dear Doctor,
    Could you please give me your opinion of “the reed” neurotransmitter implant for relief of migraine. I assume there are other similar procedures, I was just curious how effective. The reed site states 80 to 90% relief or elimination of headache.
    Those kind of numbers seem to good to be true, while I hope the are.

  4. Dr. Mauskop says: 01/12/201710:58 am

    He probably wants to do what is called radiofrequency ablation o the nerves in your neck. I do not know enough about your condition to offer any advice, but generally, before destroying a nerve I try various other treatments, such as physical therapy, meditation, magnesium and other supplements, and Botox injections.

  5. Jack says: 01/12/201710:13 am

    Dear doctor, my neurologist /pain doc is going to do a nerve block at the top of my neck. If I get relief he wants to burn the nerves. I was curious what your experience and results are with this.
    Thank you, Jack

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