What is a Peripheral Nerve Block?

A Question-Answer Style Format

Will a Peripheral Nerve Block Help My Headaches?. Rafe Swan/Getty Images

Peripheral nerve blocks, or PNBs, are used for the treatment of a number of headache disorders.

Here is a look at the basics of peripheral nerve blocks using a question-answer style format:

What Primary Headache Disorders are Typically Treated with Peripheral Nerve Blocks? 

What Secondary Headache Disorders are Typically Treated with Peripheral Nerve Blocks?

Is There a Standard Way to Perform a Peripheral Nerve Block? Due to the increasing use of peripheral nerve blocks by doctors to relieve headaches, the American Headache Society Special Interest Section for PNBs and other Interventional Procedures – known as AHS-IPS – devised recommendations for performing PNBs.

What is the Benefit of Peripheral Nerve Blocks? They can provide immediate headache relief, and in some people, the pain relief can last for several weeks.

What Nerves are Targeted in Peripheral Nerve Blocks? The most commonly targeted nerve is the greater occipital nerve – located at the base of the skull. Branches of the trigeminal nerve – a cranial nerve that provides sensation to the face and allows for facial movements –  or the lesser occipital nerve may also be targeted.

How do Peripheral Nerve Blocks Work? A doctor will inject local anesthetic – either lidocaine or bupivacaine – into the nerve.

The anesthesia blocks the signaling between nerve fibers involved in pain messaging.

Are Steroids Ever Injected? Sometimes, corticosteroids – like triamcinolone – are added to the local anesthesia. Corticosteroids can also be given alone, but this is not very common. According to AHS-IPS recommendations, corticosteroids should not be injected into the trigeminal branches due to potential side effects.

Are Peripheral Nerve Blocks Done in an Operating Room? No, they are typically performed in a doctor's office and generally tolerated well by headache sufferers.

How Often Does a Peripheral Nerve Block Need to be Repeated? It depends on the person and their doctor's recommendation. But, according to the AHS-IHP recommendations,  a peripheral nerve block with local anesthetic can be repeated every 2-4 weeks. If corticosteroids are used, though, the procedure should be repeated no sooner than 3 months due to potential side effects – although, this may not be the case for greater occipital nerve blocks in people who suffer from cluster headaches.

What are the Potential Side Effects of Injected Corticosteroids?: Potential side effects include hair loss, skin thinning, darkening of the skin, or a medical condition known as Cushing's syndrome.

Can Anyone Get a Nerve Block for Headache Treatment? No, there are some people who should not get a nerve block – like those with a history of a craniotomy.

There are also concerns for administering PNBs to certain people – like pregnant women and the elderly. All PNBs need to be discussed very carefully with a person's team of doctors.

Take Home Message

The use of peripheral nerve blocks in headache treatment is an exciting intervention, but more studies need to be done to clarify its effectiveness. The long-term effects – especially when it comes to preventing headaches – are really unknown at this point.  If you are contemplating a nerve block, be sure to discuss it thoroughly with your headache specialist.

Sources

Blumenfeld A, Ashkenazi A, Evans RW. Occipital and Trigeminal Nerve Blocks for Migraines. Headache. 2015;55(5):682-89.

Blumenfeld et al. Expert Consensus Recommendations for the Performance of Peripheral Nerve Blocks for Headaches – A Narrative Review. Headache. Mar 2013;53(3):437-46.

DISCLAIMER: This site is for informational purposes only. It should not be used as a substitute for personal care by a licensed physician. Please see your doctor for advice, diagnosis, and treatment of any concerning symptoms or medical condition.

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