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.

Jürgens TP, Müller P, Seedorf H, Regelsberger J, May A.

Source

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

Abstract

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.

PMID:

22383125

[PubMed - as supplied by publisher]

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Frontal and Occipital Headaches with Facial Numbness

From Vicki:

I have right sided pain in the occipital region and frontal area. Continuous pulsation with buzzing in my ear. I am Nauseated, and have right sided facial numbness and tingling.

Dr Shapira response:

I always suggest patients with numbness in the face have a neurological work-up and patients with ear problems be evaluated by an ENT. Having said that I frequently see patients with symptoms similar to your who are very successfully treated by their diagnostic neuromuscular orthotic without drugs.

The occipital pain is usually referred from neck muscle trigger points, especially from the SCM, Trapezius,
Levator Scapulae,,splenius capitus and splenius cervicus muscles. Patients who have had long term pain may also have occipital trigger points or entrapment of occipital or greater occipital nerves. An occipital nerve block can have amazing results. Facial numbness may be from occipital nerve entrapment.

The buzzing in the ear and pulsation is usuallly from problems with the tensor palatini muscle (affects eustacian tube) or tensor tympani muscle which goes to the ear drum.

One must consider the facial nerve as well as a cause of numbness and that can be related to parotid problems.

The Trigeminal Nerve is always the primary source of frontal headaches and involved in most parietal and occipital headaches due to postural implications.

The pulsing of the Trigeminal Nerve and Facial nerve with ULF (ultra-low frequency) TENS may eliminate all problems if a diagnostic orthotic is also constructed.

Following complete (or close) pain relief a long term solution can be evaluated.