Interventional Headache Procedures

The 3 most common procedures to treat patients living with migraine and headache disorder

For the over 37 million Americans living with migraine and other disorders that cause severe headache, preventive treatments are not always effective in relieving their symptoms. The goal of interventional headache procedures is to stop or drastically reduce migraine attacks and headache. Dr. Matthew Robbins of the Montefiore Headache Center provides an overview of the various interventional procedures for those living with migraine and head pain disorders. He highlights the three most common procedures—peripheral nerve blocks, botulinum toxin and trigger-point injections—and explains how each treatment benefits patients with different migraine and headache disorders.

These procedures are particularly effective at providing patients with relief from chronic migraine and migraine because they focus on the mechanisms that cause head pain, Dr. Robbins says. “Often, the physical examination and understanding the science behind the different headache disorders helps to determine which procedures might be useful.” Read on below.

Peripheral Nerve Blocks

Peripheral nerve blocks may be effective for some living with migraine and chronic migraine. They block the pain signals travelling along peripheral nerves and are typically administered to patients via a small-needle syringe at the back of the skull (greater and lesser occipital nerves), temples (auriculotemporal nerves) or above the eyebrows (supraorbital and supratrochlear nerves).

This form of treatment can help people living with migraine in two ways: 1. Nerve blocks can provide relief during a migraine attack, if medications or other forms of treatment have failed. 2. “Nerve blocks can also work to treat people with chronic migraine by being what we would call a short-term preventive treatment or a bridge treatment,” Dr. Robbins says. This treatment can last several days, or even weeks, and lead to a reduction in the number of attacks for someone who is waiting for their long-term preventive treatment to begin working.

Botulinum Toxin

Botulinum toxin (OnabotulinumtoxinA) injections, more commonly known as Botox®, have been shown to be safe and effective for people living with chronic migraine. In fact, “This is the only approved treatment by the FDA in the United States to treat chronic migraine, which actually work for chronic migraine, but not people with migraine that is less frequent,” Dr. Robbins says.

These injections are administered with a small needle, similar to what is used in acupuncture, to a patient’s head, neck and shoulders, and are given every three months in a series that includes upwards of 30 and 40 injections. “It is very safe and tolerated quite well by many people, and it’s a great alternative or treatment to many of the oral medications that are taken daily and may be associated with intolerable side effects,” Dr. Robbins says.

Trigger-Point Injections

Trigger-point injections are an effective form of treatment for anyone living with migraine and other headache disorders.

Trigger points are areas in the muscle that are very tight and may “twitch” when pressed. If touched, the patient may feel pain directly over the site that is being palpated (pressed) as well as at sites distant from the muscle in the patient’s head and neck; otherwise known as “referred pain.” If left untreated, these trigger points can cause the head pain to persist.

Injections are given into different muscles on the scalp, neck and shoulders that cause head pain. “Trigger point injections work when the physician or practitioner treating people with headache find an area of muscle or soft tissue that seems inflamed or irritable, and that’s a target for treatment,” Dr. Robbins says.

Visit our Resource Library for educational materials on these and other headache procedures, and stay up to date on the latest news regarding current treatment options and research. The Move Against Migraine Facebook group is another excellent resource for those looking to find out the best treatment option for them. It provides a great opportunity to meet other individuals who are living with migraine and headache disorder and ask questions about the various procedures and treatment options.