Therapeutic Nerve Blocks
Therapeutic Nerve Blocks and Myofascial Trigger Point
According to recent research, many chronic tension type headaches, chronic migraine headaches and post traumatic headaches, are associated with pathology of the upper cervical vertebrae, and in particular, the cervical facet joints. In selected patients, infiltration of a local anaesthetic (nerve block) to the upper cervical paravertebral nerves, occipital nerves and cervical facet joints, is a powerful tool in breaking the headache pain cycle. This procedure often results in long-lasting pain relief.
Infiltration of local anaesthetic into myofascial trigger points in coordination with an active stretching and physiotherapy, can be an extremely effective method of treating myofoascial pain syndromes.
The Role Of Nerve Blocks In The Treatment Of Migraine And Cervicogenic Headaches
What Is A Nerve Block?
A nerve block is a method of temporarily anaesthetizing or freezing a particular part of your body making that area frozen and numb to all pain. An example of a nerve block is when your dentist freezes your tooth before filling a cavity. Nerve blocks are performed so that Doctors or Dentists can perform minor surgical procedures without the patient feeling any discomfort. Nerve blocks are also used to treat people suffering from chronic pain.
How Do Nerve Blocks Relieve Chronic Pain?
In some individuals who are suffering from chronic pain, we block or freeze the nerve that is transmitting pain impulses from a particular region of your body. The nerve remains frozen for a few hours and when the freezing wears off, patients regain full sensation. When the freezing wears off we often find that the pain is either gone or greatly reduced. This pain relief may last for an extended period of time, and in some individuals it may provide permanent pain relief. Chronic pain results often after some form of injury or accident. The damaged tissues heal over a period of weeks or month, however the nerves that innervate these tissues continue to transmit impulses into the brain were they are perceived as pain. Many pain specialists feel that nerve blocks work by breaking the chronic pain cycle, allowing nerves to “reset” themselves. When the nerve becomes unfrozen rather than transmit aberrant and false pain impulses, it functions in a normal pre injury fashion, only sensing pain due to injury or inflammation.
The Neck: A Recently Recognized Headache and Migraine Trigger
Another migraine trigger that has been recognized in provoking migraine headaches is chronic or recurrent pain in the neck. Pain stemming from the cervical facet joints, intra vertebral discs, cervical muscles, ligaments and tendons are all transmitted by nerves in the upper part of the neck to the trigeminal nerve. The trigeminal nerve and the blood vessels that it innervate is called the trigeminal neurovascular unit. The trigeminal neurovascular unit is thought to be implicated in causing the pain in migraine headaches. In individuals with damage to structures innervated by the upper cervical nerves there is a constant barrage of pain impulses into the trigeminal neurovascular unit. This constant flow of pain impulses into the trigeminal nerve from the neck increases the risk of getting a migraine headache and often results in failure of migraine therapy.
How Do Nerve Blocks Help Treat Migraine Headaches?
The trigeminal nerve is connected to the occipital nerve in the lower part of the brain, just above the spinal cord in a region called the brain stem. By freezing the occipital nerves, which act as a common relay for pain impulses from structures innervated by the upper cervical nerves into the trigeminal neurovascular unit, we are able to block all pain impulses that are transmitted into the trigeminal nerve. By blocking pain impulses into the trigeminal neurovascular unit, we are able to decrease the fatigue in the cervical trigeminal relay. This alters the sensitivity of the trigeminal neurovascular unit to the triggering stimulation from the structures innervated by the cervical nerves. There is an added benefit in that occipital nerve blocks, may also “reset” the occipital nerve and decrease future bombardment of the trigeminal vascular unit with pain impulses in the future.
What Nerves Are Blocked In Treating Headaches?
The nerves most commonly blocked in treating headaches are the occipital nerves, the upper cervical paravertebral nerves and the supraorbital nerves. The occipital nerve is a large sensory nerve located at the base of the skull nerve that provides sensation to the back half of the head. By blocking the occipital nerve we are able to freeze the back half of the head as well as blocking pain impulses relayed from structures innervated by the upper cervical nerves into the trigeminal neurovascular unit. The cervical paravertebral nerves are located just beside the facet joints in the upper part of the neck just below the base of the skull. The paravertebral nerves innervate the facet joints. The facet joints are commonly implicated as being a primary pain generator causing headaches and neck pain. The supraorbital nerve is a branch of the trigeminal nerve. It is located just above each eyebrow and is responsible for sensation on the forehead and the top of the head.
Do Nerve Blocks Work All The Time?
Nerve blocks do not work in all individuals, nor do they work all the time. The degree of pain relief and the duration of pain relief that one gets from nerve blocks is variable and often depends on the underlying cause of the chronic pain condition. Nerve blocks should not be used as the sole treatment for pain conditions. Nerve blocks work much better when combined with a multidisciplinary pain management program that includes physiotherapy, proper pain medications and pain management counselling. They provide patients with an extended and sometimes permanent period of pain relief that opens up a window of opportunity for other pain management treatments.
How Are Nerve Blocks Done?
Nerve blocks are a safe and simple procedure that are done at The Markham Headache and Pain Treatment Centre. Nerve blocks are performed by injecting a local anaesthetic (freezing solution) in the skin around the nerve that you want frozen. The region remains frozen for several hours (3-6 hours) at which time full sensation returns. You should dress comfortably and have a light meal 1-2 hours before your scheduled appointment. Some people feel a little lightheaded for a few moments after their treatment so it is important that you bring someone to drive you home.