Expert Consensus Recommendations for the Performance of Peripheral Nerve Blocks for Headaches – A Narrative Review

Headache - Tập 53 Số 3 - Trang 437-446 - 2013
Andrew Blumenfeld1, Avi Ashkenazi2, Uri Napchan3, Steven D. Bender4, Brad Klein5, Randall Berliner6,7, Jessica Ailani8,9, Jack Schim1, Deborah I. Friedman10, Larry Charleston11,12, William B. Young13, Carrie E. Robertson14, David W. Dodick15, Stephen D. Silberstein13, Matthew S. Robbins6,7
1The Headache Center of Southern California – Neurology Encinitas CA USA
2Doylestown Hospital Doylestown PA USA
3Headache Clinic at Middletown Medical Middletown NY USA
4North Texas Center for Head Face & TMJ Pain Texas A&M University, Baylor College of Dentistry Plano TX USA
5Abington Headache Center – Neurology Warminster PA USA
6Yeshiva University
7Albert Einstein College of Medicine / Montefiore Medical Center, Bronx, NY, USA
8Department of Neurology, Georgetown University Hospital, Washington, DC, USA
9Georgetown University
10Departments of Neurology & Neurotherapeutics and Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
11Neurology Michigan State University College of Human Medicine Grand Rapids MI USA
12Spectrum Health Medical Group Comprehensive Headache Care Center – Neurology Grand Rapids MI USA
13Thomas Jefferson University – Neurology Philadelphia PA USA
14Neurology Department, Mayo Clinic, Rochester, MN, USA
15Neurology Mayo Clinic Scottsdale AZ USA

Tóm tắt

Objective

To describe a standardized methodology for the performance of peripheral nerve blocks (PNBs) in the treatment of headache disorders.

Background

PNBshave long been employed in the management of headache disorders, but a wide variety of techniques are utilized in literature reports and clinical practice.

Methods

TheAmericanHeadacheSocietySpecialInterestSection forPNBsand otherInterventionalProcedures convened meetings during 2010‐2011 featuring formal discussions and agreements about the procedural details for occipital and trigeminalPNBs. A subcommittee then generated a narrative review detailing the methodology.

Results

PNBindications 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.PNBsdescribed include greater occipital, lesser occipital, supratrochlear, supraorbital, and auriculotemporal injections. Technical success of thePNBshould 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 theAmericanHeadacheSocietySpecialInterestSection forPNBsand otherInterventionalProcedures members forPNBmethodology 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.

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Headache

Tập 53 Số 3

437-446

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