The current issue of HeadWise, (Volume 4, Issue 2) from the National Headache Foundation features an article written by Dr. Robbins regarding difficult to treat refractory headaches.
Here is a portion of the article….

SPG (sphenopalatine ganglion) nerve blocks have been used for over 100 years. Several new devices are available that facilitate completing an SPG block in the physician’s office. The SPG is a nerve center near the top of the nose, between the eyes. The block is accomplished easily, and takes only a minute. No pain has been reported. A type of novocaine is sprayed up the nose via the Tx360 or SphenoCath device. SPG blocks are safe and most effective if done 2 or 3 times per week for several weeks. If effective, these blocks may provide relief for days or weeks (occasionally longer). Some neurologists and pain specialists perform the SPG blocks in their office.

Occipital nerve blocks involve injecting under the skin in the back of the head. Some type of novocaine is used, sometimes with cortisone. Although somewhat painful, occipital blocks are fairly safe. These injections may help for weeks (usually not more than one month). Some neurologists, and almost all pain specialists perform occipital nerve blocks.

Trigger point injections are usually undertaken with a type of novocaine, injected into the neck or upper back areas. The effects of these injections may last from days to weeks, and are performed by some neurologists and pain specialists.

Deeper neck (cervical) injections may help some patients with Refractory Chronic Migraine, particularly when the neck is involved. For those with neck and “back of the head” pain, these injections should be considered. These include steroid epidural injections, and “facet” nerve blocks which are performed by a pain specialist on an outpatient basis. Although generally safe, these injections carry slightly more risk than the superficial injections, and are costly.

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