Transcript Related Guidelines

Acute Treatment With Nerve Blocks

Jessica Ailani, MD · Georgetown University


July 23, 2020

This transcript has been edited for clarity.

Acute treatment with nerve blocks is often used to manage a variety of headache disorders.[1] Nerve blocks are effective by stopping the transmission of signals from a peripheral nerve, and they likely have a downstream effect on quieting central noise during a headache disorder. Peripheral nerve blocks can be a great way to treat an acute headache, because patients can come into the office when they’re not feeling well, get a nerve block, and feel much better that day. The trouble is that using this [therapy] every time one has a headache can be cumbersome. (To travel in [to the office/clinic] every single time they’re not feeling well just to receive a nerve block can be a bit of a problem.)

So, often in clinical practice, we’ll use nerve blocks to treat a headache cycle that’s been ongoing for several days. Most likely what we would see is an acute migraine status in which someone has had a migraine that’s lasted 2 to 3 days, has taken their standard medication, and they’re not feeling better. We might bring them into the office to do a peripheral nerve block.

There is some evidence that the use of a greater occipital nerve block during a migraine attack can stop the acute attack itself.[2] This greater occipital block is performed using local anesthetic. A nerve block registry study of physicians from the procedural section of the special interest group of the American Headache Society revealed that most physicians studied used bupivacaine as the only component of their greater occipital block for migraine.[3] There is also evidence that a greater occipital block can stop a cluster cycle, although there is not much evidence regarding the effect on an acute cluster attack.[4] Some case series have been published showing that a greater occipital block can help posttraumatic headache[5]and hemicrania continua,[6] and it is sometimes used during the acute headache phase for both of these headache disorders.

Sphenopalatine ganglion blocks have been studied to treat acute headache in the emergency department.[7] However, results using the Tx360 device did not provide evidence for effects that last more than the day.[7,8] Sphenopalatine ganglion blocks have demonstrated effectiveness for post-dural headaches, and they can be used to acutely treat headaches following a lumbar puncture or headaches from receiving a spinal anesthetic during a procedure such as a cesarean section without using an epidural blood patch.[9]

In summary, peripheral nerve block may be considered as an outpatient method to treat an acute headache attack that may not be responding to conventional treatment.


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