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Injections and blocks for headaches: practical details

There are different types of injections that can be made to improve neck-influenced headache (cervicogenic headache). The link between neck pain and headaches can be complex. See this post [1]The injections can be made with local anesthetics (similar to the freezing product used by dentists), lidocaine and bupivacaine are common options). 

Simple nerve blocks 

These procedures can be done in an office by any trained physician.

The product is usually lidocaine (or similar anesthetic). For occipital blocks, some physicians add injectable steroids (depo-medrol). For nerves of the face, steroids are not used. 

X-ray guided blocks and radiofrequency ablations

These procedures are usually performed by radiologists or physiatrists, often in specialized clinics

Facet blocks: 

The product is injected near the facet (where two bony surfaces overlap). Cortisone is used to decrease the inflammation [2] of the joint. 

Median Branch blocks: 

The target is a tiny nerve that conveys the sensations (and therefore pain) from the facet. Lidocaine can be injected.  

Radiofrequency ablations or rhizotomy: 

This is not a «block». No substance is injected. The physician will use an electric probe to «grill» the nerve root that may cause the joint pain. The effect of RFAs can last for many months. They can be repeated. 

Other types of injections performed by physicians or physiotherapists

Trigger point injections (or TPI) are usually used to relax tense muscles. The product injected can be saline or lidocaine. The target are «taut bands» that can be palpated by expert clinicians. 

Dry needling also targets tense muscles, but no product is injected. The needle itself is moved to bring the muscle to release. These injections can be quite painful. 

Acupuncture [3] uses very small needles inserted just under the skin. It is based on the theory of energy meridians. See our page on acupuncture [3] (See this post [4]). 

A few comments on blocks

Summary

Blocks and injections can be part of your headache management plan. They should be provided by a trained and experienced clinician. 

REFERENCES 

Blumenfeld A, et al. Expert consensus recommendations for the performance of peripheral nerve blocks for headaches–a narrative review. Headache. 2013;53(3):437-46.

Leroux E, Ducros A. Occipital injections for trigemino-autonomic cephalalgias: evidence and uncertainties. Curr Pain Headache Rep. 2013;17(4):325.

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