Conflict of Interest: None
Peripheral Nerve Blocks and Trigger Point Injections in Headache Management – A Systematic Review and Suggestions for Future Research
Article first published online: 7 MAY 2010
© 2010 American Headache Society
Headache: The Journal of Head and Face Pain
Volume 50, Issue 6, pages 943–952, June 2010
How to Cite
Ashkenazi, A., Blumenfeld, A., Napchan, U., Narouze, S., Grosberg, B., Nett, R., DePalma, T., Rosenthal, B., Tepper, S. and Lipton, R. B. (2010), Peripheral Nerve Blocks and Trigger Point Injections in Headache Management – A Systematic Review and Suggestions for Future Research. Headache: The Journal of Head and Face Pain, 50: 943–952. doi: 10.1111/j.1526-4610.2010.01675.x
- Issue published online: 1 JUN 2010
- Article first published online: 7 MAY 2010
- Accepted for publication March 25, 2010.
- peripheral nerve blocks;
- trigger point injections;
- headache management;
- systematic review
Interventional procedures such as peripheral nerve blocks (PNBs) and trigger point injections (TPIs) have long been used in the treatment of various headache disorders. There are, however, little data on their efficacy for the treatment of specific headache syndromes. Moreover, there is no widely accepted agreement among headache specialists as to the optimal technique of injection, type, and doses of the local anesthetics used, and injection regimens. The role of corticosteroids in this setting is also debated. We performed a PubMed search of the literature to find studies on PNBs and TPIs for headache treatment. We classified the abstracted studies based on the procedure performed and the treated condition. We found few controlled studies on the efficacy of PNBs for headaches, and virtually none on the use of TPIs for this indication. The most widely examined procedure in this setting was greater occipital nerve block, with the majority of studies being small and non-controlled. The techniques, as well as the type and doses of local anesthetics used for nerve blockade, varied greatly among studies. The specific conditions treated also varied, and included both primary (eg, migraine, cluster headache) and secondary (eg, cervicogenic, posttraumatic) headache disorders. Trigeminal (eg, supraorbital) nerve blocks were used in few studies. Results were generally positive, but should be taken with reservation given the methodological limitations of the available studies. The procedures were generally well tolerated. Evidently, there is a need to perform more rigorous clinical trials to clarify the role of PNBs and TPIs in the management of various headache disorders, and to aim at standardizing the techniques used for the various procedures in this setting.