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Occipital Nerve Block

  • By Julie

    Has anyone ever had an Occipital Nerve Block done on them to treat Migraines? I have those w/the intense stabbing behind the one eye w/the visual distubances and pain also on that same side of the head, the LH side. I was seriously considering that treatment and my doctor is holding off on that waiting to see how this round of new medication combination was going to work before we’d consider that route as, of course, the insurance would not cover it as they didn’t cover the cose of the Botox injections I had done a couple of years ago.

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  • By Ellen Schnakenberg

    Julie – Fortunately these blocks can help some Migraineurs eliminate one trigger for their Migraines. It also may be a good treatment if you have a comorbid condition such as Occipital Neuralgia.

    No, I’m afraid it doesn’t work on everyone, or we’d all be doing it. However, it is quick and fairly easy to do, and might be worth the try at some point. If it doesn’t work, you can always continue trialing other treatments, as even a failure still teaches us something we didn’t already know…

    However, trialing any medicine takes months after each change. It is likely your doctor wants to be sure that you are appropriately trialing the current medication combo you are on. Changing something at this point would only confuse things… something to consider…

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  • By Julie

    Thank you for the fast reply. I know it’s impossible to say I’ve tried everything because I know I haven’t. After having these things for 25 years. The past 2 1/2 years they’ve become Intractible and I do not abuse my rescue meds because I don’t want to get caught up in that rebound migraine cycle. It’s bad enough as it is, why put gas on the fire. The Botox didn’t work well, but I only tried it one time also. Such a complicated disease and so many medicine combinations it just makes a sick persons head spin even more! If only they could come up with a solution. It’s just so exhausting. Thank you for your input Ellen. I will ride the course I’m on and wait and see what the Doc suggests next.

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  • By Vicky Wemyss

    I had an occipital nerve block in April this year. Unfortunately it didn’t help me at all, but the neurologist warned me that there was only a 50% chance it would work. I have recently tried Botox as an alternative.

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  • By Nancy Harris Bonk Moderator

    Hi vickywemyss,

    Thank you for letting us know about your treatment experience with an occipital nerve block. I’m sorry it wasn’t successful for you.

    I’ll be keeping my finger crossed that Botox works. It seems to be very effective for chronic migraine and I’d like to share this information on it in this link; https://migraine.com/blog/the-first-week-chronic-migraine-and-botox-diary/.

    Do come back and let us know how it is going.

    Nancy

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  • By SapphireDream

    I’ve just had my second occipital nerve block injected yesterday. Unfortunately it has had absolutely no affect on my chronic cyclic migraine. My neurologist wants me to have the injections up to 6 times before he calls it a failure again. I tried Botox as well between the occipital injections, which also sadly was ineffective.

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    • By Katie M. Golden Moderator

      SapphireDream,
      I’m sorry they haven’t worked for you. I agree with you doctor that you should keep trying it. I’ve had several nerve blocks. Sometimes they work really well for me and other times they trigger a bad Migraine. So who knows?! But with Botox, I’ve heard doctors say you definitely need to try it 2 or 3 times before giving up.

      It’s hard when you want a quick fix, but stick with it a little longer and maybe you’!ll see results. Fingers crossed for you!
      -Katie

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  • By SapphireDream

    Katie,

    I agree that it can cause a worse migraine. I’ve been laid up unable to move since the second one. I’m trying to have patience, it’s just really hard to see that light at the end of the tunnel when everything seems to be getting dimmer.

    ~S

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  • By Bellajb

    I had the Occipital Nerve Block done for the second time yesterday. The weirdest feeling today is that I know I have a migraine however I can’t feel it fully. It’s actually not very comforting. As I felt it coming on, I took panadeine forte and nurofen, said no to a drink and cheese at a friends house and bolted for home.

    Actually, it’s been a very difficult 24 hours. The injection site is really sore. Last night I practically slept on my face and today I drove the 4 hours home trying to avoid resting my head on the head rest. Now I’m sitting up in bed, contemplating taking more nurofen before attempting to lie down.

    Last time I had it done I definitely had a reduction in migraine severity for about 2 months. Based on that (and the 3 month waiting time to get an appointment at the Pain Clinic in Adelaide) I decided to try it again.

    I’m actually planning on having botox in about 6 months. The last statistics I heard was around a 30% success rate. 12 months ago I decided that wasn’t good enough odds. Now I’ll try anything to get some relief! – BB

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  • By cdfjones

    I had an occipital block 1 week ago and had my 4th round of Botox the next day. My stiff neck and pain in the back of my head are gone. I do have the pounding daily headache around the temple area, but it is only about a 3. If I get busy I can forget about it for a while. I am considerating occipital oblation. We are going to see how long the block lasts.

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  • By Sam

    I had an occipital nerve block a few months ago unfortunately it did not work for me. The doctor said it might not because I don’t usually have pain in the back of my head. My pain is usually around my temples and the sides along with the front of my head. The nerve block made the back of my head sore for weeks.

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  • By drkhorsandi

    I perform Occipital Nerve Blocks weekly on my patients. I mostly use it as a diagnostic tool to confirm that a patients cause of pain is due to greater occipital or lesser occipital nerve compression. The results are variable from physician to physician for multiple reasons and even in my experience I do not expect this to be a long term solution to treating occipital neuralgia. Reasons for variability: (1) site placement of the injection. The injector should know the location of the nerves. Many do not. (2) the medication injected – I use a combination of anesthetic and steroid (usually Depo-medrol). (3) Quantity of medication injected. If a patient comes into my office with pain in the the occipital region, we usually inject them that day and are able to get their pain down immediately. Long term the average relief is about 7-14 days. I have one patient that gets about a year relief from a single injection. The reason I use it for diagnostic purposes, is to evaluate patients for surgical nerve decompression. The nerve is compressed by the tight tissues and muscles in the back of the neck. Nerves cause pain, and the only true way to alleviate the pressure on the nerve is to release the tissues compressing it. Botox has moderate length improvement on occipital neuralgia (however that is another topic for discussion).

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    • By Ellen Schnakenberg

      DrKhorsandi

      Are you a Migraine and Headache Specialist? I ask because of a few reasons:

      With over 300 different headache disorders, it can be very difficult for a patient to get an appropriate diagnosis by someone who hasn’t had the opportunity to have the specialized training necessary for patients that require a lot of thought. Also, to stay up to date on the best treatments for patients. Occipital neuralgia isn’t Migraine, but it is often a trigger for Migraine, and vice versa. We talk mostly about Migraine here, but this is a subject of interest to a number of our members.

      I recently took the AHS class for the injection of Botox and nerve blocks, and it was stated at that time, that it was no longer recommended to use steroids in concert with the blocking agent. It was found to be unnecessary.

      You mention that you do nerve decompression, and I’m wondering if you are actually decompressing the nerve, or cutting it. Some surgeons use the term decompression, but actually are cutting the nerves, and specialists’ position on this is quite negative for Migraine treatment. Again, we’re talking ON though, so I’m wondering if you have any research links you’d like to share to educate those who may be wondering if surgery might be helpful for them?

      And what about the use of stims before the leap to surgery? For our patients who are Migraineurs, stims are being used with increasing frequency and often include a combination of occipital and supraorbital for best results. Again, specialists consider this experimental at best and tend not to suggest it except with patients who are refractory to all other treatment.

      As to Botox for ON, I found that my ON is caused by dystonic spasms in my neck an a suspected entrapped nerve, and the Botox injections for my Migraines incidentally stopped the spasms aggravating the entrapment and my ON. I can sure tell when my Botox wears off, but for me, at this time, it is the answer I needed.

      Thank you for your participation here, and I look forward to your responses.

      ~Ellen

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  • By drkhorsandi

    Yes I am a specialist, I perform occipital nerve decompression surgery for patients that suffer from chronic migraines, and it has been determined that the compression from the greater occipital nerve is the cause of their migraines.

    I agree there are many different headache disorders and ways to categorize them. I am trying to get migraine sufferers to change the way they think of their condition. The majority of the patients that see me with migraines, have as their cause a chronic nerve compression. The majority of the ones we see in the occipital region have occipital neuralgia. Peripheral nerves when compressed cause pain. Pain leads to the aura like symptoms one experiences with migraines. If you alleviate the pain by taking the pressure off of the nerve, then your migraine like symptoms go away. This is the logic behind what I do and why it works!

    For specifically the block, we use it as a diagnostic test. I was at a recent meeting with neurologists and surgeons, and there was no consensus regarding using a steroid with anesthetic. For supraorbital and temporal blocks, I use pure anesthetic, for occipital, I have found clinically it to be more effective with the steroid.

    My technique for the surgery is nerve decompression, in other words, freeing the nerve from the surrounding tissues, and making sure nothing will compress it. I also use some fat from under the skin to create a soft bed for the nerve, and to help reduce adhesions. My feeling is that it is not the nerves fault, it is the tight tissues such as muscle and fascia surrounding it that causes the compression. Earlier on, doctors did recommend nerve root avulsion, and some surgeons still do it. While it is not entirely wrong to do, I prefer to keep the nerves intact. They provide feeling.

    Regarding stimulators. They require to be placed surgically as well. Often a two step process where the first step is a trial, and second step is permanent. There is a role for pain stimulators as 15% of all surgical nerve decompressions fail. Pain stimulators are implantable devices, so there is a battery and several wires inside you. They can get infected (and quite often). There is a chance if not placed properly, the stimulator lead can migrate or move from the intended location. There is no published data on success rate of these stimulator. Conceptually, you are blocking or diverting pain signals from the compressed nerve. The nerve remains compressed. Why not go to the source of the problem? I do use pain stimulators but for the above reason if surgery fails.

    Botox is a wonderful drug. I use it all the time. For occipital neuralgia, keep in mind the muscles are large and deep. We sometimes use emg guidance to ensure we are effectively inserting the botox into the muscles, and not the subcutaneous tissues.

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    • By Katie M. Golden Moderator

      OWR25,
      It looks like you had previously seen Dr. Ducic for a consultation for nerve decompression surgery. Were you required to see one of Georgetown’s Headache Specialists to determine if you were a candidate?

      I ask because I go to Georgetown for my chronic migraine condition and I see Dr. Jessica Ailani. I’m also familiar with her colleague Dr. Carrie Dougherty. If you saw one of them for your initial consultation, then you’re already in the Georgetown system and could probably get in sooner than if you had just been referred. A new patient appointment usually takes about 6 months to get in.

      Just based on my experience, Georgetown has the best headache specialists in the DC area.
      I hope this helps.
      -Katie

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    • By katieg

      I saw a few people before I found Dr. Latimer who is in Georgetown and I think is excellent. http://www.bethlatimermd.com/
      She specializes in peds and adolescents, but takes people with headaches of any age and they actually got me in within a week. Apparently she believes people with headaches shouldn’t have to wait months for an appointment. With the two prior neurologists I had to wait months to see them.

      I’m new to migraines – I am 34 y/o female and only had them for 8 months, but they are chronic and even days that aren’t migraines are pretty bad headaches. I was on amitriptyline for about two months and topamax for a month but neither were making a huge difference in number of days or frequency – although they did help with the severity.

      Anyway, I had an occipital block today and it made a huge difference for me right away. The back half of my head doesn’t feel like someone is trying to break out of it with a thick soldering iron anymore; so I am thrilled. As I understand the steroid in the injection will also reduce the inflammation which will make the Botox injections more effective (going on Thursday). That makes sense to me and it’s relieved my pain now.

      We’re all so different, but this was very helpful for me for the last 7 hours and my doctor said it can last a few weeks and it means there is a good chance the Botox will also work. Good luck and I hope this helps.

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    • By rachelbtrim

      My daughter received nerve blocks, but they only worked for about 8 hours. So she did get relief, but it was short lived. Could this still mean that there is an issue with the nerves being compressed? Would surgery be something we could look into realistically? She also is having vision problems. She says it is like looking through Saran Wrap, but doctors say there is nothing wrong with her eyes. The vision problem is 24/7 and with school about to start it is going to get worse because she has to focus more.

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  • By Not-Again

    Hello! I have been diagnosed with occipital neurolagia, TMJ, and compression of the C5, C6, C7. I also have a piece of bony structure in my C5, C6 area touching the nerve. I have had one Botox session, two nerve block sessions, and two epidural procedures with MRIs in between, and most recently a platelet rich plasma injections. I get very sensitive behind my ears (both sides, my migraines are on the right side.) The best thing, in my opinion, is in all of the different types of injections, my neurologist uses either an ultrasound machine or a fluroscopy machine to guide where the injection needs to be. I am experiencing much less pain, fewer migraines, and more range of motion in my neck and upper back area.

    I understand that while those of us who have migraine disease want everything to work immediately to get us out of pain and all the side effects of migraines, our care team needs time to make sure if it is the preventative medications working, is it a procedure combined with preventative or abortive medications working…..

    Hope can be difficult to find when waiting and in pain. I hope you will find the best treatment for you very soon. When it doesn’t happen as fast as I want it to, I ask God to help me wait as best I can until the pain goes away.

    Blessings to you and all of us with migraine disease,
    Not-Again

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  • By Katie M. Golden Moderator

    Not Again,
    I am always excited to hear when someone has good news to share about their treatment. That’s great news! Thanks for sharing how your doctor administers your treatments. That’s a good thing to know that others could maybe request this approach.

    Thanks for sharing!
    Best Wishes,
    Katie
    Migraine.Com Moderator

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  • By Katie M. Golden Moderator

    Not Again,
    I am always excited to hear when someone has good news to share about their treatment. That’s great news! Thanks for sharing how your doctor administers your treatments. That’s a good thing to know that others could maybe request this approach.

    Thanks for sharing!
    Best Wishes,
    Katie
    Migraine.Com Moderator

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  • By Howard Fites

    I had a nerve block of a combination of anesthetic and steroid about a month ago. The immediate effect was great relief and much greater mobility of my neck and head. My Neurologist who also suffers from migraines said success is a mixed bag some do great many do not. This process will help her determine the next step in my care. My immediate goal is a reduction in my use of Imitrex which has been excessive. In addition to the injection she put me on a number of dietary supplements and Lidocaine/prilocaine Topical Cream which I really liked until I had a side effect of painful blistering of the skin.

    Overall I have slowed my use of Imitrex some. She advised me that like many Imitrex users I don’t use it correctly. Like many I tend to “hoard” my Imitrex and put off taking it until I have no option. Now I take it at the very first sign that a migraine is coming on. This has greatly reduced my rebound migraines and I no longer get that post Imitrex groggy stupid feeling.

    I plan to go in and have additional blocks, perhaps every month to start. If this proves to be a help surgery could be in my future for a more permanent fix. I have been lucky in that my insurance (Kaiser) is covering my treatments so I don’t have the added worry of cost on top of everything else.

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  • By Stormy25

    I just had an Occipital Nerve block today so will see if it helps, my Doctor is hopeful, we tried Botox and it was not very helpful for me.

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  • By poetdoll

    I have been having migraines off and on for 15 yrs. this last chronic round (15+ m’s a month) lasted till about my 5th treatment of botox. I am self self pay and elected to have botox at $1500 a pop! DEFINITELY WORTH IT! I had migraines 3-5 m’s a week. I go for my 6th round in 3 weeks & am down to 1 m every 2 weeks. I DID have extenuating circumstances in my timeline (travel, sickness, reducing my daily migraine med (mistake!) maybe I could have had more stability sooner. In addition to botox I am on a daily med, topamax, rescue meds, imitrex & relpax and use essential oils: I can use as much as needed w/o scary side effects. my m treatment is definitely multi-pronged. my Neuro has recommended a n block bc I have periods of migraines (3 or 4 in a short period of time) as the botox treatment wears off and b4 it kicks in again. my ? is this: is the n block worth pursuing to cover the gap in the “waxing & waning” of the botox?

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    • By Katie M. Golden Moderator

      @poetdoll,
      I have been using botox for 5 years now. About 2 years ago I started to get 2 nerve blocks in between botox treatments. I have found them to be helpful. As you stated, the effects don’t last as long, but it is nice to get additional relief in between.

      If feels like your scalp is numb, like when you go to the dentist who gives you novacaine and you can’t feel your face. It goes away after a few hours, but the effects can help for a week or so. You’re already used to needles with botox, so it wouldn’t hurt to try. I’m not a doctor, just wanted you to know my experience with nerve blocks.
      Best Wishes!
      -Katie
      Migraine.com Moderator

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  • By Sharron17

    I have had Occipital Nerve Block injections in October 2016 for the relief of daily chronic migraines. I was amazed as I got nearly 3 months of virtually pain free. I had them again on 31st January 2017 and they have not worked. I tried a daith piercing but this hasn’t worked either. I am due to try the injections again tomorrow as my Consultant said it can be hit and miss. I have previously had botox 4 times but this hasn’t worked either. Don’t give up. Just because something doesn’t work once doesn’t mean it won’t work again.

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