Nerve Block for Chronic Migraine

By: Brooklyn A. Bradley, BS; Medically edited by Dr. Deena Kuruvilla, MD

If you are someone who has chronic migraine, you may know how challenging it can be to find effective relief. Peripheral nerve blocks have been suggested to reduce the frequency and severity of migraine attacks [1]. In today’s blog post we will discuss nerve blocks, focusing specifically on what they are, how they work, and how they might help you find much-needed relief from your migraine.

The occipital nerves are a group of nerves that arise from the C2 and C3 spinal nerves and innervate the posterior scalp [2, 3]. The three major occipital nerves include the greater occipital nerve (GON), the lesser occipital nerve (LON), and the third occipital nerve (TON). The GON is the largest of these three nerves, and innervates the posterior scalp [2]. The GON also has a role in the trigemino-cervical complex (TCC), which may be related to the co-occurrence of neck pain and headache [4]. The C2 sensory nerves in the neck are connected to the trigeminal nucleus caudalis (TNC) in the head. This means that pain signals from the head and neck share a common pathway. Because of this connection, blocking the GON may be an effective way to reduce pain and prevent different types of headaches [2, 4]. 

An occipital nerve block is a medical procedure that involves injecting medication near the GON [2]. Nerve blocks that target the GON are more often used to treat refractory headaches when other pharmacological options have failed [5]. The provider can inject anesthetic (i.e. lidocaine or bupivacaine) alone near the GON. In terms of the safety of the GON block procedure, most side effects are mild and transient [2]. There may be pain, redness, and/or swelling at the injection site. Some people may experience dizziness, numbness, or lightheadedness after the procedure. The duration of relief can vary from person to person [2]. Some may have pain relief for several weeks or even months, while others might need repeat injections more frequently to provide relief [6].

Migraine is often connected to overactive pain signals in the nerves [6]. The occipital nerves play a major role in transmitting these pain signals from the scalp and back of the head to the brain. When these nerves become irritated or inflamed, they can contribute to headache and migraine attacks. By blocking these nerves with an injection, the pain signals can be reduced or stopped, and thus providing relief from migraine symptoms. In a randomized double-blind study in 2023 studying the use of an occipital nerve block for the preventive treatment of chronic migraine, researchers found that four-weekly greater occipital nerve blockade with 2% lidocaine for 12 weeks was superior to the control group in decreasing the average number of headache and migraine days in patients with chronic migraine [7]. Another study found that patients treated with bupivacaine (a type of anesthetic) had a decrease in frequency of headache at the first, second, and third months of follow-up [8]. However, more studies are needed to better highlight the safety and cost-effectiveness of the occipital nerve block in chronic migraine.

Some additional nerve blocks we would like to mention include the supraorbital, supratrochlear, and auriculotemporal nerve blocks. The supraorbital nerve (SON) is one of the terminal branches of the trigeminal nerve, and provides innervation to the upper eyelid, forehead, and scalp [9]. Some complications of SON block procedure may include eyelid swelling, infection, bleeding, and nerve injury. A 2019 study found that the GON and SON blockage with lidocaine was more effective than placebo in the preventive treatment in both the episodic and chronic migraine groups [10]. The supratrochlear nerve (STN) is another division of the trigeminal nerve, and provides innervation to the bridge of the nose, the forehead, and some areas of the eyelid [11]. Some complications of the STN block may include bleeding, infection, or injury to the nerve. Some studies have illustrated that SON and STN blocks have shown efficacy in conjunction with GON blocks for both the treatment and prevention of migraine headaches [12, 13]. 

Finally, the auriculotemporal nerve (ATN) is another one of the terminal branches of the trigeminal nerve, and runs on the top part of the jawbone, travels up near the ear, and goes up to innervate the scalp [14]. Damage to this nerve can trigger headaches or facial pain, which can be worsened by opening the mouth widely or pressing hard on the temporomandibular joint. There are a few patients who have undergone ATN blocks and experienced relief from temporomandibular neuralgia; however, current evidence does not show improvement in pain relief from migraine [15, 16].

In conclusion, nerve blocks are a treatment option that can be considered when managing chronic headaches. By targeting the nerves responsible for pain transmission, these nerve block procedures may be able to provide significant relief and improve your quality of life. Nerve blocks are not only considered prevention, but also as a transitional treatment to break a severe migraine cycle, also known as status migrainosus. It is essential to consult with a healthcare professional to get personalized advice and treatment options tailored to your needs.

 

References:

  1. Shauly O, Gould DJ, Sahai-Srivastava S, Patel KM (2019) Greater Occipital Nerve Block for the Treatment of Chronic Migraine Headaches: A Systematic Review and Meta-Analysis. Plast Reconstr Surg 144:943–952. https://doi.org/10.1097/PRS.0000000000006059
  2. Austin M, Hinson MR (2024) Occipital Nerve Block. In: StatPearls. StatPearls Publishing, Treasure Island (FL)
  3. Yu M, Wang S-M (2024) Anatomy, Head and Neck, Occipital Nerves. In: StatPearls. StatPearls Publishing, Treasure Island (FL)
  4. Terrier L-M, Fontaine D (2021) Intracranial nociception. Rev Neurol (Paris) 177:765–772. https://doi.org/10.1016/j.neurol.2021.07.012
  5. Tepper SJ, Stillman MJ (2013) Cluster headache: potential options for medically refractory patients (when all else fails). Headache 53:1183–1190. https://doi.org/10.1111/head.12148
  6. Chowdhury D, Datta D, Mundra A (2021) Role of Greater Occipital Nerve Block in Headache Disorders: A Narrative Review. Neurol India 69:S228–S256. https://doi.org/10.4103/0028-3886.315993
  7. Chowdhury D, Tomar A, Deorari V, et al (2023) Greater occipital nerve blockade for the preventive treatment of chronic migraine: A randomized double-blind placebo-controlled study. Cephalalgia 43:3331024221143541. https://doi.org/10.1177/03331024221143541
  8. Gul HL, Ozon AO, Karadas O, et al (2017) The efficacy of greater occipital nerve blockade in chronic migraine: A placebo-controlled study. Acta Neurol Scand 136:138–144. https://doi.org/10.1111/ane.12716
  9. Napier A, De Jesus O, Taylor A (2024) Supraorbital Nerve Block. In: StatPearls. StatPearls Publishing, Treasure Island (FL)
  10. Özer D, Bölük C, Türk Börü Ü, et al (2019) Greater occipital and supraorbital nerve blockade for the preventive treatment of migraine: a single-blind, randomized, placebo-controlled study. Curr Med Res Opin 35:909–915. https://doi.org/10.1080/03007995.2018.1532403
  11. Yaghoubian JM, Aminpour S, Anilus V (2024) Supertrochlear Nerve Block. In: StatPearls. StatPearls Publishing, Treasure Island (FL)
  12. Ilhan Alp S, Alp R (2013) Supraorbital and infraorbital nerve blockade in migraine patients: results of 6-month clinical follow-up. Eur Rev Med Pharmacol Sci 17:1778–1781
  13. Caputi CA, Firetto V (1997) Therapeutic blockade of greater occipital and supraorbital nerves in migraine patients. Headache 37:174–179. https://doi.org/10.1046/j.1526-4610.1997.3703174.x
  14. Chim H, Okada HC, Brown MS, et al (2012) The auriculotemporal nerve in etiology of migraine headaches: compression points and anatomical variations. Plast Reconstr Surg 130:336–341. https://doi.org/10.1097/PRS.0b013e3182589dd5
  15. Levin M (2010) Nerve blocks in the treatment of headache. Neurotherapeutics 7:197–203. https://doi.org/10.1016/j.nurt.2010.03.001
  16. Demirsoy MS, Erdil A, Tümer MK (2021) Evaluation of the Efficacy of Auriculotemporal Nerve Block in Temporomandibular Disorders. J Oral Facial Pain Headache 35:326–331. https://doi.org/10.11607/ofph.2949
Published On: July 1st, 2024