Nerve Blocks for Headache

What is a nerve block?
A peripheral nerve block is a procedure that uses local anesthetic medications to block messages coming from sensory nerves. By numbing specific nerves, nerve blocks can provide temporary or long-term relief from pain. We use them to try to break severe or prolonged headache pain. It is very similar to the injection of novocaine that a dentist uses to anesthetize a tooth.

Why are nerve blocks being considered for my child?
Nerve blocks help adults with several different types of headaches including acute migraine, status migrainosus (meaning a headache that has lasted a few days or longer), chronic migraine, post-traumatic headache (headache after head injury/concussion), hemicrania continua, and cluster headaches. Several studies in teenagers, including studies done here at CHOP, have shown similar benefit with a low risk of serious side effects.

How are the nerve blocks done?
We usually use a local anesthetic medication, lidocaine, and a very small needle. In specific circumstances we add steroid along with the anesthetic. Injections are done over the nerves that control sensation in the area that hurts. For example, if pain is on one side at the back of the head, then 1 or 2 injections will probably control that pain. Many patients have pain all over the head, so more injections are needed.

How will this help my child’s pain?
At first, these anesthetics block sensation, so your child will feel numbness as well as decreased pain. We expect the numbness to wear off in a few hours. For reasons we do not understand, in some people the pain relief will last much longer than the numbness, sometimes many days or even a few weeks.

What are the possible side effects?

• The medication will burn when it is injected. For most people this wears off very quickly.  The medication will cause a temporary bump until it is absorbed by the skin and may cause redness. These can last for a few minutes to hours.

• Some people report that their head feels “spacey” or that they feel nauseated while their head feels numb.

• Some people become very anxious about the procedure.  Anxiety can make the headache more severe, and rarely can cause fainting.

• Some people feel sore at the injection sites after the numbness wears off. If this happens you can try putting ice on the spots for a few minutes at a time to relieve discomfort.

• Among those people whose pain returns within a few days, some report that the pain feels more severe.

• There are low risks of itching, rash, allergic reaction, and significant bleeding.

• There are very low risks of infection and damage to the nerves.

Reviewed July 2024 by Christina L. Szperka, MD, MSCE