Chapter 5, Episode 4: Nerve Blocks for Migraine Disease

This content has been medically reviewed by Ruth Kennedy, NP & Dr. Beth E. Robertson

A nerve block is a procedure performed to prevent localized pain from events such as surgery or childbirth…but it can also be a valuable option for the acute or preventive treatment of migraine as well as other headache disorders.

A peripheral nerve block is administered by a clinician who injects a small amount of local anesthetic, or numbing solution, such as lidocaine or bupivacaine, around a specific nerve for pain relief. They may add a corticosteroid for longer-lasting anti-inflammatory effects or other ingredients to relieve the initial sting of the injection.

There is one type of block that does not always require an injection called the sphenopalatine ganglion or SPG block. This may be administered with a needle through the cheek or with a dab of anesthetic from a sponge or soft catheter via the nasal cavity.

Experts believe that nerve blocks can interrupt and “reset” the pain feedback loop. Repeated nerve blocks can have a cumulative effect, providing relief for longer intervals and reinforcing that “reset.”

Nerve blocks for migraine are administered to specific sites around the head and neck such as the occipital nerve, supraorbital nerve, supratrochlear nerve, auriculotemporal nerve, and the sphenopalatine ganglion.

Although local anesthetics usually wear off within hours, nerve blocks may provide pain relief for days to weeks to months in people with migraine. Generally, nerve blocks may be repeated every 2-4 weeks, but those with corticosteroids should be limited to once every 3 months.

Nerve blocks can be especially useful for people who..

  • Don’t respond to other treatments
  • Are withdrawing from acute treatments because of medication overuse headache
  • Are waiting for a preventive treatment to reach full effectiveness
  • Have breakthrough symptoms between doses of onabotulinumtoxinA or Anti-CGRP monoclonal antibodies
  • Need an additional acute or preventive treatment
  • Or are pregnant or breastfeeding

Peripheral nerve blocks may cause a temporary increase in headache as well as numbness or pain in the area it was administered. All injections carry the risk of infection, bruising or bleeding. Caution is recommended for people who faint with injections or use blood thinning medications.

For the SPG block delivered by a sponge or catheter, temporary numbness in the throat and a bad taste in the mouth can occur.

Nerve blocks may be useful for many people living with migraine because they can be used in combination with other acute and preventive treatments, they have minimal side effects and contraindications, and they often last for weeks to months.

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*The contents of this video are intended for general informational purposes only and does not constitute professional medical advice, diagnosis, or treatment. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. AMD does not recommend or endorse any treatment, products, or procedures mentioned. Reliance on any information provided by this content is solely at your own risk.