Nerve Blocks May Provide Rapid Relief in Headache

Add Steroids for Cluster Headache

In greater occipital nerve injections for cluster headache, steroids (ie, 40 mg of triamcinolone or 20 mg of methylprednisolone) should be used with the local anesthetic, according to randomized controlled trials. For migraine, studies have found that adding steroids to the local anesthetic is not beneficial.

Steroids can cause systemic and local effects, including fat atrophy and alopecia. Vasovagal attacks are another safety concern. Older patients on blood-pressure medication might be more susceptible to becoming hypotensive. In patients who have had a craniotomy, the anesthetic can diffuse through a prior craniotomy site and have direct intracranial effect, which could be hazardous. Injecting an anesthetic without steroids does not raise cosmetic concerns. Those administering nerve blocks must know the relevant anatomy of the nerves and local vasculature. For example, occipital blocks are often done above the skull base to reduce risk.

—Jake Remaly