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Monday, March 19, 2012

Occipital Nerve Block Effective in treating and eliminating a variety of headaches.

Ihave been treating chronic headches , neuralgias and facial pain with occipital nerve blocks and greater occipital nerve blocks for many years. This study showed less effectiveness in treating facial pain and neuralgias.

A major problem with many studies is that they ty to minimize the number of variables. While this is good for clinical studies to determine effectiveness of single treatments it is detrimental in comprehensive patient care.

I frequently combine occipital nerve blocks with ULF TENS, Diagnostic Orthotics, Trigger Point injections and SPG blocks. There is enormous crossover in symptoms as well as neural connections that are excitatory or inhibitoy between these structures..

Blocks and combinations of blocks and trigger points utilized with a diagnostic neuromuscular orthotic and ULF TENS give almost universal improvement and frequently elimination of symptoms. These combinations are appropriate for treating chronic pain, especially tension-type headaches, migraines, cluster headaches and autonomic cephalgias.

I will usually teach patients how to block the SPG (sphenopalatine ganglion) at home to prevent headaches and migraines when the diagnostic orthotic doesn't eliminate the headaches completely.

J Headache Pain. 2012 Mar 3. [Epub ahead of print]

Occipital nerve block is effective in craniofacial neuralgias but not in idiopathic persistent facial pain.


Department of Systems Neuroscience, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.


Occipital nerve block (ONB) has been used in several primary headache syndromes with good results. Information on its effects in facial pain is sparse. In this chart review, the efficacy of ONB using lidocaine and dexamethasone was evaluated in 20 patients with craniofacial pain syndromes comprising 8 patients with trigeminal neuralgia, 6 with trigeminal neuropathic pain, 5 with persistent idiopathic facial pain and 1 with occipital neuralgia. Response was defined as an at least 50% reduction of original pain. Mean response rate was 55% with greatest efficacy in trigeminal(75%) and occipital neuralgia (100%) and less efficacy in trigeminal neuropathic pain (50%) and persistent idiopathic facial pain (20%). The effects lasted for an average of 27 days with sustained benefits for 69, 77 and 107 days in three patients. Side effects were reported in 50%, albeit transient and mild in nature. ONBs are effective in trigeminal pain involving the second and third branch and seem to be most effective in craniofacial neuralgias. They should be considered in facial pain before more invasive approaches, such as thermocoagulation or vascular decompression, are performed, given that side effects are mild and the procedure is minimally invasive.

[PubMed - as supplied by publisher]

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posted by Dr Shapira at 6:12 PM

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