Head and Neck Blocks for Headache and Facial Pain

Abstract

Since medications and interventions may not yield adequate efficacy for many patients with headache and facial pain, the management of these complex conditions often requires a multidisciplinary and multimodal effort. As part of a multifaceted approach, different procedures may have utility in alleviating pain for a variety of pathologies. This article reviews practical considerations for performing occipital nerve blocks, trigeminal nerve blocks, cervical medial branch blocks, cervical epidural steroid injections, sphenopalatine ganglion blocks, and trigger-point injections. Although there is growing evidence for the utility of these varied procedures, further research is warranted to clearly define which patient groups may derive the greatest benefit from these interventions, as well as optimal approaches to enhance their effectiveness. Most recent advances covered (3-5): 1. Greater occipital blocks performed with lesser occipital blocks are a useful therapy to complement conservative management to reduce length, frequency, and duration of migraine headache. 2. Cervical medial branch blocks may be helpful for not only for neck pain, but for headache, however, more research is needed in this area. 3. Although dry needling is effective for myofascial pain, injection of local anesthesia may provide longer lasting relief.