Nerve blocks and nerve stimulation in headache disorders

Abstract

Nerve blocks and neurostimulation can be useful therapeutic options in patients with head and neck neuralgias. In addition, these peripheral nerve procedures also can be effective in primary headache disorders, such as migraine and cluster headache. Nerve blocks for headache generally are administered by the use of small subcutaneous injections of amide-type local anesthetics like lidocaine and bupivacaine. Targets include the greater occipital nerve, lesser occipital nerve, auriculotemporal nerve, supratrochlear and supraorbital nerves, sphenopalatine ganglion, cervical spinal roots, and facet joints of the upper cervical spine. Neurostimulation generally targets the upper cervical and suboccipital regions and the greater occipital nerves. This article summarizes the techniques, proposed mechanisms, and effectiveness of these commonly used anesthetic procedures and electrical stimulation procedures for head pain conditions. There are unfortunately few controlled studies of nerve blockade and neurostimulation, so, despite numerous positive reports of their usefulness, firm evidence for these procedures is lacking. There is therefore a serious need for randomized, blinded, sham-controlled studies of the nerve block and nerve stimulation procedures which have been reported as potentially helpful for headache and facial pain disorders.