For Migraine Headache:
Headaches at least 15 days per month for more than 3 months; have features of migraine headache on at least 8 days.
Features of migraine headache:
- Lasts 4 to 72 hours;
- Has at least 2 of the following 4 characteristics:
- Moderate or severe pain intensity
- Aggravates or causes avoidance of routine physical activity
- Associated with:
- Nausea and/or vomiting
- Photophobia and phonophonia
(In ICHD-2, absence of medication overuse was one of the diagnostic criteria for chronic migraine. In the ICHD-3, this criterion was removed from the chronic migraine diagnosis and “medication overuse headache” is now a separate diagnostic category.)
For Cluster Headache:
Patient has had at least five attacks occurring from one every other day to eight per day; and attributable to no other disorder.
Headaches must cause severe or very severe unilateral orbital, supraorbital, or temporal pain lasting 15 to 180 minutes if untreated, and be accompanied by one or more of the following: ipsilateral conjunctival injection or lacrimation, ipsilateral nasal congestion or rhinorrhea, ipsilateral eyelid edema, ipsilateral forehead and facial sweating, ipsilateral miosis or ptosis, or a sense of restlessness or agitation.
Episodic cluster headache is defined as at least two cluster periods lasting seven to 365 days and separated by pain-free remission periods of one month or longer. Chronic attacks recur over more than one year without remission or with remission lasting less than one month.
(Headache Classification Subcommittee of the International Headache Society.
The International Classification of Headache Disorders. 2d ed. Cephalalgia. 2004;
For Medication-Overuse Headache
Patients with a pre-existing primary headache who, in association with medication overuse, develop a new type of headache or a significant worsening of their pre-existing headache (or one of its subtypes) should be given both this diagnosis and the diagnosis of the pre-existing headache.
Defined as headache occurring on 15 or more days/month in a patient with a pre-existing primary headache and developing as a consequence of regular overuse of acute or symptomatic headache medication (on 10 or more or 15 or more days/month, depending on the medication) for more than 3 months. It usually, but not invariably, resolves after the overuse is stopped.
- Headache occurring on ≥15 days/month in a patient with a pre-existing headache disorder
- Regular overuse for >3 months of one or more drugs that can be taken for acute and/or symptomatic treatment of headache
- Not better accounted for by another ICHD-3 diagnosis.
(The International Headache Society third edition of the International Classification of Headache Disorders (ICHD-3). )
- Nasal or Sinus tumors
- Nasal Foreign Body/Polyps
- Brain Tumor
- Anti-Viral Medication use
- Post Radiation Therapy
- Post Craniotomy Headache
- Headaches due to Increased ICP * (?Topamax)
- Post Trigeminal Nerve Decompression
- Careful Selection Of Patients
- Not For Occipital Neuralgia Or Cervicogenic Headaches
- Not Effective For Drug Seekers
- Less Effective For Patients With Severe Psychiatric Co-Morbidities
- Ages 14 years old and above
- Check Blood Pressure Before SPGNB
- Defer Block If Elevated BP Over 180/90
- 10 To 30 Second Procedure
- 25 TO 0.3 mL OF 0.5% MARCAINE TO EACH SPG
- Always Perform Bilateral Procedure.
- Fast response.
- Relief Last over 24 Hours
- Repetitive Nerve Blocks for autonomic neuromodulation
Repetitive Blocks for Neuromodulation (protocol):
Treatment Frequency: 2-4 Injections Per Week For 3 to 6
Weeks Duration (up to 12 Total Injections)
FREQUENCY IS KEY TO NEUROMODULATION
Consider bilateral occipital nerve block
Once successfully treated initially, then 1 to 3 nerve block every 3 months.