Spinal Block Migraine Treatment
Migraine is a severe, debilitating headache. Several treatment options effectively manage pain, but some migraines fail to respond. For people who have frequent, severe migraines that cannot be controlled with standard therapies, a spinal nerve block may relieve chronic pain. A steroid injection reduces inflammation in tissues surrounding the nerve, eliminating the source of pain. Such nerve blocks are temporary and repeated injections are necessary for continued pain relief.
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Migraine Characteristics
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Migraine is distinct from other types of headaches. A migraine is characterized by a severe throbbing pain usually confined to one side of the head, and it is accompanied by sensitivity to light or sound, nausea and vomiting. If left untreated, a migraine attack may last from four to 72 hours and the pain may be debilitating. Standard migraine treatment (for example, nonsteroidal anti-inflammatory medications and triptans) effectively relieve migraine pain, but some migraines resist treatment. Inadequately treated migraines may become chronic daily headaches. People who have severe migraine more than 15 days per month may be candidates for nerve block therapy.
Spinal Nerve Block Process
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Spinal nerve block is used for chronic pain management and may be effective for chronic migraines. For migraine treatment, a local anesthetic and a steroid is injected next to the occipital nerve, which is located at the base of the skull. The process takes only a few minutes and sedation is unnecessary. The anesthetic numbs the area and immediately relieves pain, although it wears off after several hours. The steroid controls inflammation and swelling of the tissues surrounding the occipital nerves, which causes the pain. The steroid takes effect within two to three days and lasts for several days to a few months. If pain persists beyond three days after the injection, another injection or two may be necessary.
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Use of Occipital Nerve Block
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Occipital nerve block treatment is only recommended for people who suffer from frequent, severe migraines that are uncontrolled with other therapies. If the nerve block successfully relieves pain, injections are repeated when the pain returns. Patients receive no more than three injections in a six-month period to reduce the incidence of side effects. If more are needed for adequate pain relief, a different type of treatment should be considered.
Side Effects
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Pain at the injection site is the most common side effect associated with occipital nerve block, and the injection of the steroid may be painful initially. Other side effects include infection, bleeding and worsening of pain. Nerve block should not be administered to people who are allergic to any of the medications, or those who are taking blood thinners (for example, warfarin). People who have an infection or poorly controlled diabetes or heart disease should also avoid occipital nerve block.
Occipital Nerve Stimulation
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Electrical stimulation of the occipital nerve offers an alternative to nerve block for chronic migraine. A device implanted in the abdomen sends electrical pulses through a lead passed up through the body to end near the occipital nerve. Study results found the device effectively reduced pain and number of headaches per month compared with patients who did not have the implant. The device has not yet been approved for use by the Food and Drug Administration.
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