Peripheral Nerve Blocks & Trigger Point Injections: Interventional Procedures for Headaches and Facial Pain

January 26, 2024
July 6, 2022
Peripheral Nerve Blocks & Trigger Point Injections: Interventional Procedures for Headaches and Facial Pain

Peripheral nerve blocks and trigger point injections have been utilized in the treatment of a variety of headache disorders for many years. These injections can provide prompt relief for acute exacerbations, and are beneficial to those experiencing status migrainosus and even chronic migraines. They are well tolerated, safe, and effective. In addition, drug interactions are of little concern.

Medications used are a local anesthetic such as lidocaine or bupivacaine to numb the area and corticosteroids to help reduce inflammation. The combination of medications are injected via a small-needle syringe targeting superficial nerves to the scalp. Some of these nerves are located to the back of the head, temples, and above the eyebrows.

Nerve blocks are effective in desensitizing the overactive pain signal from the nerve to the brain. In addition, numbness to the area can last for a few hours providing quick relief and improving intensity of pain. A nerve block if successful can last for several days to several weeks, and are found to be more effective with each subsequent treatment.

Left: Occipital injection site; Center: Auriculotemporal injection site; Right: Supraorbital injection site

Occipital Nerve Block

The most widely used procedure is the occipital nerve block (ONB). Several studies have shown the efficacy of performing a ONB in treatment of occipital neuralgia, migraine, daily chronic headache, cervicogenic headache, and cluster headache.  During an ONB, the greater and lesser occipital nerves are infiltrated with a combination of a lidocaine-type medication and corticosteroids. Patients who often benefit from this procedure are those who experience pain to the back of the head, and find their headache reproduced when pressure is applied to these nerves.

Supraorbital Nerve Block

The supraorbital nerve block (SONB) treats the supraorbital and supratrochlear nerves which can cause pain around the eye, forehead, eyebrow, and scalp. This is found to be effective for supraorbital neuralgia, migraine, and cluster headache. A local anesthetic without corticosteroids is used to treat the area.

Auriculotemporal Nerve Block

The auriculotemporal nerve arises from the mandibular branch of the trigeminal nerve. It innervates the temples and the temporomandibular joint. A nerve block to this area can help relieve pain around the jaw, ear, and temple.

Sphenopalatine Ganglion Blocks

Another procedural therapy completed in the office involves blocking the sphenopalatine ganglion (SPG), a group of nerve cells behind the nose linked to the trigeminal nerve. A thin plastic applicator is placed into each nostril delivering a numbing medication around the SPG. This can take about 10-20 seconds to perform. The results can take anywhere from 15 minutes and last to a few hours. This can be performed for acute exacerbations, chronic migraines, trigeminal neuralgia, and non-migraine headaches. For preventive treatment, SPG blocks can be performed twice per week for a 6 week period improving chronic migraines.  

Trigger Point Injections

Most patients with migraines and other headache conditions do have musculoskeletal pain contributing to their symptoms. Trigger point injections are a great way to treat painful areas to the muscles around the neck and shoulders.  The injection includes a lidocaine type medication and may include corticosteroids.

Botox Treatment

Botox (Botulinum toxin) is injected to various areas of the neck and scalp as a preventive treatment for chronic migraines. Administered up to 39 injection sites. Treatment is based on the PREEMPT protocol where they found these specific areas to be effective when treating chronic migraine (see image below).

Botox injection sites

If you are considering any of the above procedures, talk with a neurologist or headache specialist to find out what could be right for you. Neura's clinicians are available for video consultations, and can refer you to a local provider if you are a good fit for one of these treatments.

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Jasmine Bhasin, PA-C
Jasmine Bhasin is a Physician Assistant specializing in headache medicine, based in the San Francisco Bay Area.
About the Author
Jasmine Bhasin is a Physician Assistant specializing in headache medicine, based in the San Francisco Bay Area. Prior to joining Neura Health, she worked in the Department of Neurology at UW (University of Wisconsin) Health where she specialized in migraine and headache disorders. Jasmine began her career in family practice and aesthetics where she adopted an interest in alternative medicine. She continues to focus patient care based on preventative medicine with a holistic approach, where treatment plans are incorporated with non-pharmacologic management such as lifestyle changes, alternative medicine, physical therapy, and supplements. She also performs botox injections, supraorbital nerve blocks, occipital nerve blocks, and trigger point injections. Jasmine completed her undergraduate degree in Human Development at UC San Diego. She went on to receive her Master of Science in Physician Assistant studies from Western University.

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