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Surgical Options

C2 Nerve Block

  • By Monkeybrew

    Hello to the group. Next week I am schedule to have a bilateral C2 nerve block, my first in a short series, at Chelsea Memorial Hospital in Chelsea Michigan. The procedure is being performed by the physician that heads up the Pain Program at the Michigan Head Pain and Neurological Institute in Ann Arbor.
    I have a long history of Migraine and Chronic Migraine and have worked through many different treatment options over the years with MHNI. I am excited to have something to try that I have not tried before. And, I am curious to hear others’ experiences with C2 nerve blocks. I have had Occipital and Supraorbital nerve blocks. Neither of those were too painful as they were not “deep” blocks. I understand C2 is a deeper block. From what MHNI told me and what my research finds, it may involve some sort of radiological or ultrasound guidance.
    I would to hear from those who have had this type of block.

    Thanks!
    MB

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  • By Nancy Harris Bonk Moderator

    Hi MB,

    Welcome and thank you for sharing your story with us! I’ve not had this done, but do have information I can share with you.

    This link will take you outside Migraine.com to the Today Show where Doctor Saper (who is wonderful!) is doing what I think is the same procedure. Yes, it is under fluoroscopy. This should help; http://www.today.com/health/block-migraine-pain-back-head-injection-8C11440964.

    Good luck and let us know how it goes!

    Nancy

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  • By Monkeybrew

    Hello to the group. I thought an update would be in order as I had my second round of nerve blocks earlier today.

    The blocks I had today are the same as the blocks I mentioned in my original post here. Although effective, the first bilateral C2 block lasted only two days. For me two days without migraine is a miracle. I have had daily migraines of varying intensity for a very, very long time.

    So, the good news is that a treatment interrupted the migraine. The bad news is that two days is not enough relief!

    The physician and I had discussed the idea that there may be a need for multiple blocks before things get into a state of better control. I am hopeful that this will indeed be the case.

    Today’s block went just like the first. I cannot say enough about the staff and the care I received. The procedure itself is a non-event as there are sedatives given before the real fun begins. I experience some mild soreness later in the day and into the next day, but nothing more severe.

    As I write this update I am trying to stay positive even though I have a migraine. I know the block was not necessarily going to make this particular migraine go away. After the first block I had a migraine the next day and then the two migraine free days began. Perhaps this time I am getting the migraine out of the way today so that tomorrow can be a better day!

    If, as I hope, this block also brings about some relief I will be discussing next steps with the physician. Do we do a third block? Do we try to get my insurance carrier to pay for radio frequency nerve ablation? Are there other viable options, like implants…

    All I know is I need to find some relief that lasts longer than a couple of days. I feel worn out, beaten down, drained, tired, etc., etc….

    I continue to infuse these thoughts with a more positive and hopeful voice. In the midst of a migraine (like now) of significant intensity it is hard to be positive.

    Expect another update tomorrow.

    Thanks to the group.

    MB

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  • By Nora M

    Good Morning MB!

    I came across this post and I wanted to let you know that I hope you are feeling better and that you got some relief. It is hard going through this process– the pain, the procedures, the insurance. They don’t make it easy.

    I had a similar block at Chelsea Hospital with MHNI in April of 2014. Mine was a Facet C2-C5. I had two while I was there, and I’ve had one here in Georgia. I am scheduled for Radio frequency Ablution but am scared. Anyway– i can empathize.

    Thinking healing thoughts!

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  • By Monkeybrew

    Hello again to the group.

    Please allow me to provide an update. After my second bilateral C2 block I spoke with the physician, via his nurse by phone (six hour round trip for me to get to the clinic or to Chelsea). In both the first and second blocks I had periods of time where I was either at a pain level around one or two, or completely pain free, that lasted between one and two days. For me to get a full day of low level or no pain is absolutely miraculous! Needless to say I was anxious to talk about something as a next step that might be longer lasting in the way of relief.

    I shared all this with the nurse during our phone conversation. She seemed excited about the progress and mentioned radio frequency ablation as a possible next step. At least two other team members at MHNI have also mentioned this procedure as a likely next step for my treatment path.

    A few days later the nurse called back and said that the physician wanted to do one more, a third, nerve block. With this series of three, she said, we could go to my insurance company to get approval for the ablation procedure. It all made sense.

    Then I waited for the scheduler to call. That happened last week and I was lucky enough to grab a cancellation slot for last Friday. If I had not taken that slot I would have had to wait for another month!

    So, Friday I went for my third bilateral C2 block. The procedure itself was pretty much the same as the first two. The only exception is that I “woke up” a bit during the procedure. They do not put me completely out, but do pump some pretty good meds through the IV to deal with the pain of the large needles. There is also an amnesia agent that puts one in a state where one does not recall much. I came up out of this fog to feel some pretty intense pain on the right side of my neck as the needle was going in, or was progressing or something. I mumbled to the team that it hurt pretty bad and I presume they put more meds in the IV because after that I recall nothing until being in post-op / recovery.

    This third block followed a very similar course in relationship to the migraine. I went into the procedure with a fairly decent migraine in place (7 on a one to 10). The physician, when I shared this with him prior to the procedure, said, “Oh you are doing pretty bad today huh?” I told him 7 was not really all that bad for me. A 10, and I am dead in the water, but I have developed some coping techniques that allow me to function, temporarily and in short bursts, at pain levels near (not at) the top of the scale. In any event, he noted the level and off I went. Post procedure the migraine stayed about the same. Later that evening it started to move upward and topped out in the late evening at 9. The next morning, Saturday, the migraine was still at a 9. I pursued my normal path with some abortive medications. For several hours the migraine continued.

    By mid-day yesterday the migraine was down to a one or two on the pain the scale. By evening the migraine was completely gone! This morning, Sunday, the migraine is still gone! Some odd sensations seem to indicate that something, maybe the migraine, is really still there, but I am not feeling it, or sensing it as pain. Whatever is going on, I will take the pain-free time!

    The second block followed a very similar path. A migraine going into the block, that got worse after, with relief coming later. If this block follows the path I should expect to have a great day today (odd to think or write something like that!). Unfortunately, the pattern to this point would suggest that the migraine may return tomorrow. I am hopeful that this third in the series might help to extend the relief.

    Regardless of whether I get any more relief I am confident that we have established a grounds for insurance approval of the ablation procedure. Three blocks with three migraine-free periods of time after each block. We have finally found an actual spot/location and specific treatment that can completely disrupt the migraine! To this point (after two decades of working with physicians and healthcare providers) I have never found anything that could so effectively and reliably impact the migraine like this!!!!

    It would seem this is nothing short of a turning point in the war!!! My experience with migraine, and my low energy and depressed mood, however, keep me from getting too excited. I am not jumping up and down. I am not on the roof screaming and shouting. I am, as years of living in chronic pain have taught me, keeping it low-key… I guess fearing the next migraine. Yet, there is a voice, rising and becoming more insistent, that has more to say than, “migraine, migraine, migraine, migraine…”

    Next steps… I expect the nurse to phone me tomorrow. I have my migraine log and notes ready. She will, I expect, pass along my experience to the physician. Unless something changes I expect he will want to proceed with getting insurance approval for the ablation.

    The idea of more than two consecutive days without migraine is such a foreign concept. I am not sure I can wrap my head around that!

    I will continue to update this thread / post.

    MD

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  • By migrainestl

    Hi there–I was just recently referred to MHNI so an curious…did you start out as an inpatient at the Chelsea Hospital? What was your experience & how long did you stay? I live a 9hr drive away from MHNI & have a 13mo old. I’m eager to get any relief I can, but also hopeful we can come up w/ a plan that doesn’t require a long stay or frequent trips back & forth.

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    • By Monkeybrew

      Migrainestl,

      When I had the C2 root nerve blocks it was outpatient for me. My drive time is 3.5 miles one-way, which is much shorter than your 9 hour drive! In total I have had three of the C2 root nerve (I hope I am getting that correct) blocks done outpatient. The blocks were successful although the relief only lasted from one to two days. It is extremely rare to have a full day without of some kind of migraine appearing. Before going into the inpatient program the physician performing the blocks was beginning to bring up the topic of radiofrequency ablation at the site of the nerve blocks.
      Concurrent to this I was also attending my scheduled appointments with my neurologist and psychologist. Before we could get to the ablation I ended up going into the inpatient program that MHNI has at Chelsea Community Hospital.

      My stay in the inpatient program was just shy of two weeks. In fact I have only been home for two days. I can tell you that time invested in the inpatient program is both of value and is helpful. One of the biggest advantages to going inpatient is the speed at which medications can be changed and evaluated. In the outpatient setting it was not uncommon to make two or even just one change in medications and then schedule a follow up visit for a month or six weeks. Inpatient, it can literally be a single day.

      Another significant advantage to the inpatient program, in my opinion is the access to procedures such as nerve blocks and lumbar punctures. Such procedures in an outpatient setting can take similar and even longer periods of time to schedule.

      Lastly, and perhaps most importantly, is the access to Dr. Saper and a truly wonderful and knowledgeable team of staff. Every morning each inpatient meets with the entire team, lead by Dr. Saper. Not only does the team talk about one’s case, but the patient has the opportunity to share feedback, ideas and questions. Sometime after rounds have concluded each patient is visited by the Physician Assistance assigned to them. This is a more detailed conversation that what occurs at rounds. Any changes in medications or treatment are highlighted and the reasons behind such changes are discussed. The level of detail goes down to the level of which abortive medications to try that day and in what order to try them. This helps expedite the creation of a post-inpatient medication plan.

      I can share much more detail if you would find it helpful. I am certainly willing to correspond directly via email or continue this thread here at Migraine.com. What is lost by “taking the conversation off-line” is the ability of other members to read the thread in order to gain a better understanding of the inpatient program.

      I feel for you with a young child and the long distance. I am not aware of MHNI artificially capping the length of stay for circumstances like yours, but then again I did not inquire, nor did anyone that I spoke with while on the inpatient unit.

      What I can say is that I highly recommend this course if your migraines have become chronic, out-of-control, and so terribly intrusive that living an semblance of a life is simply impossible.

      Having said that, I can also tell you that I have, for years (far too many) worked with MHNI and their staff on an outpatient basis.

      In conclusion, MHNI does also have an outpatient four-day IV infusion program that I went through last year. This provided some degree of relief.

      I know I said “in conclusion”, but I will add this… MHNI is not the only specialty clinic / group that deals with migraine and head pain. I would encourage you to make certain there is not a reputable, specialized clinic closer to your home.

      If I can provide any further details of my experience or answer any other questions please do not hesitate to contact me and/or post to this thread.

      Take Care,
      MB

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  • By Monkeybrew

    I went through MHNI’s outpatient IV infusion program and was inpatient. I still had to stay in the area (it is a 3.5 hour drive for me). This meant booking a room at one of the local motels in Chelsea. This added expense was not the most pleasant as it was a bit costly.

    As far as the program goes, it was helpful. It consists solely of IV infusion three times daily. I spent eight or so hours at the hospital on IV each of the four days.

    It did break a bad cycle of high intensity migraines, but never broke my daily frequency. The relief lasted a few months before sliding back into a higher intensity cycle.

    MB

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  • By Bellajb

    I’ve had Occipital and the C2 nerve block here in Australia. They didn’t put me under anaesthetic and provided no pain relief. I can honestly say it was one of the most traumatising experiences of my life. It took me hours to recover to a point I could leave the hospital. They told me that they needed me conscious so that they knew when they were in the right position i.e. they had hit the nerve because I would react. As I recall, the needles were the size of skewers – it was absolutely barbaric!

    Saying that, I had some relief. My migraines were less severe for about 4-5 weeks.

    I haven’t heard of an in-patient program here, but I’d be very keen to do it if it was on offer!

    I’m going to try botox next month. Nothing else has worked and I have nothing to lose!

    BB

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  • By Monkeybrew

    Bellejb,

    I am sorry to hear that your C2 block was done without anesthetic or pain relief. I am also sorry to hear that you do not have access to an inpatient program. I can say, three days out from the inpatient program, that it appears to have been very helpful.

    To the topic of this thread, C2 root nerve block. After three bilateral C2 root nerve blocks I have found complete relief for between one and two days. That’s time completely free of any migraine pain. In my case, this is something that simply never happens. I may not have a migraine all day every day, but I always have some degree of migraine for several to many hours of every day.

    Before going into the inpatient program it was looking like radiofrequency nerve ablation at C2 was the next step. Having spent two weeks in the inpatient program that may very well still be part of the next steps.

    In addition to the bilateral C2 root nerve block I also had, during the inpatient program, an Occipital nerve block, bilateral cervical facet C2 – C5, a lumbar puncture (opening pressure 18, closing 110), bilateral supra orbital, supra trochlear and zygonatictemporal nerve blocks.

    I have been told that the steroids take a “few days” to kick into gear. Those few days have now passed and I must say that the last couple of days I have noticed a marked difference in the migraines. I am still experiencing a migraine each day, but the intensity has dropped off substantially.

    Of course, it is not only the nerve blocks, but my entire medication regime that changed. In fact, everything was dismantled and rebuilt with nearly all different medications.

    So, as I come to the end of this update… The questions are: Is the improvement due to the nerve blocks, and if so, which ones? Or, is the improvement the result of changes to medications?

    I would love to hear feedback, comments, thoughts, experiences, etc., etc.

    As always, thanks to all for your time and attention!!!

    MB

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  • By LKing

    I have had nerve blocks with no success, but currently after a year of Botox find that they help lessen the intensity of my headaches/migraines and I no longer have the nausea. It did take numerous injections before I started to see the benefit. My current neurologist has advised me that the more you have it performed the better the effects and results from the Botox are. Good luck.

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  • By JanetM

    Dear MB,
    Your last posting was a few years ago and I’m interested in reading a current update. I’m scheduled to attend the inpatient program at MNHI at the beginning of 2018 for the C1&C2 nerve block.

    Any info regarding your migraine status today would be both helpful and encouraging.

    Thanks,
    Janet

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