Expert consensus recommendations for the performance of peripheral nerve blocks for headaches - A narrative review

Andrew Blumenfeld, Avi Ashkenazi, Uri Napchan, Steven D. Bender, Brad C. Klein, Randall Berliner, Jessica Ailani, Jack Schim, Deborah I. Friedman, Larry Charleston IV, William B. Young, Carrie E. Robertson, David W. Dodick, Stephen D. Silberstein, Matthew S. Robbins

Research output: Contribution to journalReview article

94 Scopus citations

Abstract

Objective To describe a standardized methodology for the performance of peripheral nerve blocks (PNBs) in the treatment of headache disorders. Background PNBs have long been employed in the management of headache disorders, but a wide variety of techniques are utilized in literature reports and clinical practice. Methods The American Headache Society Special Interest Section for PNBs and other Interventional Procedures convened meetings during 2010-2011 featuring formal discussions and agreements about the procedural details for occipital and trigeminal PNBs. A subcommittee then generated a narrative review detailing the methodology. Results PNB indications may include select primary headache disorders, secondary headache disorders, and cranial neuralgias. Special procedural considerations may be necessary in certain patient populations, including pregnancy, the elderly, anesthetic allergy, prior vasovagal attacks, an open skull defect, antiplatelet/anticoagulant use, and cosmetic concerns. PNBs described include greater occipital, lesser occipital, supratrochlear, supraorbital, and auriculotemporal injections. Technical success of the PNB should result in cutaneous anesthesia. Targeted clinical outcomes depend on the indication, and include relief of an acute headache attack, terminating a headache cycle, and transitioning out of a medication-overuse pattern. Reinjection frequency is variable, depending on the indications and agents used, and the addition of corticosteroids may be most appropriate when treating cluster headache. Conclusions These recommendations from the American Headache Society Special Interest Section for PNBs and other Interventional Procedures members for PNB methodology in headache disorder treatment are derived from the available literature and expert consensus. With the exception of cluster headache, there is a paucity of evidence, and further research may result in the revision of these recommendations to improve the outcome and safety of these interventions.

Original languageEnglish (US)
Pages (from-to)437-446
Number of pages10
JournalHeadache
Volume53
Issue number3
DOIs
StatePublished - Mar 1 2013

Keywords

  • auriculotemporal
  • bupivacaine
  • cluster headache
  • corticosteroid
  • greater occipital
  • headache
  • intervention
  • lesser occipital
  • lidocaine
  • migraine
  • peripheral nerve block
  • supraorbital
  • supratrochlear

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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    Blumenfeld, A., Ashkenazi, A., Napchan, U., Bender, S. D., Klein, B. C., Berliner, R., Ailani, J., Schim, J., Friedman, D. I., Charleston IV, L., Young, W. B., Robertson, C. E., Dodick, D. W., Silberstein, S. D., & Robbins, M. S. (2013). Expert consensus recommendations for the performance of peripheral nerve blocks for headaches - A narrative review. Headache, 53(3), 437-446. https://doi.org/10.1111/head.12053