Migra Well

Migraine Pain Management Injectables

Migraine Pain Alleviation Injectable therapies offer targeted relief for individuals suffering from chronic migraines. These treatments include Botox injections, nerve blocks, and trigger point injections, each designed to reduce the frequency and severity of migraine episodes.

Nerve Blocks: Occipital & Trigeminal

Nerve Blocks, specifically Occipital and Trigeminal Nerve Blocks, are used for the treatment of various headache disorders including chronic migraine, cervicalgia (neck pain), occipital neuralgia, and cervicogenic or muscle contraction headaches. They are used both as a preventative and abortive treatment for these conditions.

Occipital Nerve Blocks

This procedure involves injecting a local anesthetic, often lidocaine, near the occipital nerves located at the back of the head.

This procedure is used for the treatment of various headache disorders, including chronic migraine, cervicalgia (neck pain), occipital neuralgia, and cervicogenic or muscle contraction headaches.

During an occipital nerve block, a healthcare provider injects a local anesthetic, often lidocaine, near the occipital nerves.  This can help to numb these nerves, reducing or eliminating headache pain. The procedure is quick, usually taking less than 5 minutes, and there's no downtime required.

Hand of a doctor injecting an occipital nerve block behind the head of a young woman

Trigeminal Nerve Blocks

This procedure is similar procedure to occipital nerve but targets the trigeminal nerves instead. Thes trigeminal nerves are  responsible for transmitting sensations from the face to the brain. A specific type of Trigeminal Block called the Supraorbital Nerve Block targets a branch of the trigeminal nerve on the forehead that can be helpful in reducing pain in this area related to a migraine. 

Both types of nerve blocks can be administered monthly or as needed. The procedure is quick, taking less than 5 minutes, with no downtime required.

Side Effects
Common side effects include pain at the injection site and minimal bleeding.

Hand of a doctor injecting a nerve block in the trigeminal nerve of a young man

Sphenopalantine Block

The Sphenopalatine Ganglion (SPG) Block is a targeted procedure aimed at alleviating migraine pain by addressing the sphenopalatine ganglion, closely associated with the trigeminal nerve, crucial in headache syndromes. By applying a local anesthetic directly to this ganglion, located behind the nose, the SPG Block can significantly reduce or halt migraine pain.

The treatment typically involves a non-invasive method using a micro-catheter, such as the TX-360, to administer anesthetic through the nostril, offering rapid pain relief. Patients may undergo this procedure 1-2 times weekly for 6-12 sessions, with maintenance treatments as needed. Additionally, a home-based option using a lidocaine nasal spray, similar to allergy treatments, is available for acute migraine management, complementing clinic-based SPG Blocks. This approach not only serves as a preventive measure but also as an immediate migraine relief method.

While minor side effects like discomfort or a bitter taste might occur, the procedure's potential to decrease migraine frequency and severity makes it a favorable option for many sufferers.

Trigger Point Injections

Trigger Point Injections are used to treat myofascial pain syndrome, often associated with migraines. They involve an intramuscular injection of an anesthetic agent, typically lidocaine, into palpably taut muscle bands, knots, and trigger points. They are used as an adjunct treatment for migraine, particularly beneficial in cases where neck pain is highly comorbid with migraine. While primarily used for pain management, Trigger Point Injections can have a preventive effect on migraines, particularly in cases where muscle tension is a significant trigger.

The procedure is low risk and involves inserting the anesthetic into specific areas identified as trigger points.

Initial Treatment begins with an initial session where the specific trigger points are identified and injected. The frequency of follow-up injections can vary; some patients may require injections every few weeks, while others may benefit from less frequent treatments. The treatment schedule is usually assessed and adjusted based on the patient's response. If the injections are effective in reducing pain and migraine symptoms, they may be continued as part of a long-term management strategy.

Regular follow-up appointments are important to evaluate the effectiveness of the treatment and to adjust the treatment plan as needed.

Side Effects

Common side effects include temporary pain and soreness at the injection site. Rarely, patients may experience infection, bleeding, or an allergic reaction to the anesthetic.

Doctor hold syringe prepare for injection,Epidural analgesia,Epidural nerve block, spinal block,Health care concept. ,

Caution: 

When exploring options for migraine treatment, it's essential to consider the safety profiles and cautionary advice associated with the treatment options mentioned above.

Please note that this information serves as a general overview, and individual responses to medications can vary. Always consult with a healthcare provider to tailor treatment to your personal health needs.

REFERENCES

  1. Blumenfeld AM, Stark RJ, Freeman MC, et al. (2018). "Long-term study of the efficacy and safety of onabotulinumtoxinA for the prevention of chronic migraine: COMPEL Study." Journal of Headache and Pain. 19(1):13.

  2. "Botulinum Toxin Type A as a Migraine Preventive Treatment" (Dodick DW et al., Headache, 2005).

  3. Inan LE, Inan N, Karadaş Ö, et al. (2015). "Greater occipital nerve blockade for the treatment of chronic migraine: a randomized, multicenter, double-blind, and placebo-controlled study." Headache. 55(6):784-97.

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

  5. Calandre EP, Hidalgo J, García-Leiva JM, Rico-Villademoros F. (2006). "Trigger point evaluation in migraine patients: an indication of peripheral sensitization linked to migraine predisposition?" European Journal of Neurology. 13(3):244-9.

  6. Cady R, Saper J, Dexter K, et al. A double-blind, placebo-controlled study of repetitive transnasal sphenopalatine ganglion blockade with Tx360® as acute treatment for chronic migraine. Headache 2015, 55:101-116