Headache Protocol

[Pain Applicant1]

There must be over 1000 years of pain experience on this forum. What have you guys found to work best, if anything, for HA, especially those intractable migraines.

For tensions I used a lot of TPIs
I do a lot of GONB, ATNB, and SONB
CMBB, especially of 3rd occipital nerve has worked at times
Waldman prefers CESI and TCA
I've only done a small amount of Botox for HA

I've also cut out my fluorescent lamps and replaced with full spectrum lighting. The office is darker but has a much calmer vibe to it.

What's your experience?

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[lobelsteve]

CESI? Smoke that crack.

MBB C3/4/TON
SPG could be tried.
Splenius TPI for acute migraine
Defer 31 site botox to neurology.

Midrin (Prodrin)
No opiates in guidelines are supported.

Occipital stim after they fail out of Diamond or other national clinic.

 

[drusso]

I've smoked a little of the CESI for headaches crack. I think it "treats other problems" that trigger headaches.

I've done SPG blocks for HA's/face pain, and Botox

 

[facets]

fry the he## out of the 3rd occipital nerve. Neuritis is bad if you only partially destroy this large pesky nerve. Notorious for ha in woman and pts with osteoarthritis ddd Don't be wimpy, 18 guage, at least 3 burns I've done up to 5, they feel like their scalp is sunburned for a few weeks, lyrica, flextor, oxy, steroids if not c/i, they feel good for 2 years. Go all the way to the foramen, not halfway, the nerve takes longer to grow back. Always check foramen views in the neck, always, plus ap and lateral, each and every time. Never had a complication.Give yourself 45 minutes, don't be half as# esp in a neck

 

[facets]

PS aggressive is not equal to cavaliar. Check and recheck all views every time you move a needle esp in a neck. Be very careful about where you are, make sure the patient can respond. Then incinerate

 

[Ligament]

fry the he## out of the 3rd occipital nerve. Neuritis is bad if you only partially destroy this large pesky nerve. Notorious for ha in woman and pts with osteoarthritis ddd Don't be wimpy, 18 guage, at least 3 burns I've done up to 5, they feel like their scalp is sunburned for a few weeks, lyrica, flextor, oxy, steroids if not c/i, they feel good for 2 years. Go all the way to the foramen, not halfway, the nerve takes longer to grow back. Always check foramen views in the neck, always, plus ap and lateral, each and every time. Never had a complication.Give yourself 45 minutes, don't be half as# esp in a neck

Totally agree.

Burn that little bastard!!!!!!!! 18ga 10mm active tips multiple burns. I move up and down from these starting positions attached.

Works great in young women and old folks.

Other than that, SPG, stellates, gasserian, botox, supraorbitals (big tip here, they can work wonders). Pulse any of these if you are getting good but short term relief.

 

[specepic]

for acute, I do a trio of cervical TPI, ONB/LONB, SONB, works like charm, will take them from 60 to zero/close tozero in about 5 minutes

 

[drf]

Agree with above. For non-interventional management, we often do IV DHE x 5 days or 24 hours past headache resolution. I also use IV lidocaine if DHE doesn't work.

 

[Pain Applicant1]

I might have learned more on this forum website than during fellowship.

 

[facets]

Don't u love the smell of Napalm in the morning?
Those bad boys are going down!

QUOTE=Ligament;12326333]Totally agree.

Burn that little bastard!!!!!!!! 18ga 10mm active tips multiple burns. I move up and down from these starting positions attached.

 

[PMR2008]

I might have learned more on this forum website than during fellowship.

I would like to design a fellowship in which I spend a month with each one of you guys In all seriousness lobelsteve would you mind if I spend a week shadowing you some time this year?

 

[lobelsteve]

I would like to design a fellowship in which I spend a month with each one of you guys In all seriousness lobelsteve would you mind if I spend a week shadowing you some time this year?

Come on down. We've had a few folks visit for a few days at a time. My practice is an open book.

 

[lovebailey2001]

What is the experience of 'Suboccipiatl Compartment Decompression' of the forum! especially for occipital headaches.

Also, how you guys decides abt the involvement of C1-2/ C0-1 joints, I have not seen anyone with pain provocation on nodding and/or retraction of neck.

 

[101N]

What is the experience of 'Suboccipiatl Compartment Decompression' of the forum! especially for occipital headaches.

Also, how you guys decides abt the involvement of C1-2/ C0-1 joints, I have not seen anyone with pain provocation on nodding and/or retraction of neck.

C1/2: old patients age > 65, flex chin-to-chest and attempt to rotate. Exquisite, suboccipital pain that may or may not radiate to vertex (C2). Get a dens view, C1/2 joints arthritic. CT through the joints will show the same and sometimes C2 root encroachment. Injections, either C2 root block or intra-articular C1/2 don't provide lasting relief. Not all surgeons are comfortable with a fusion, but it works.

C0-1: something you read about in text books but never need to do.

Suboccipital compartment decompression: whoha. Stim occipital nerve pain.

 

[pmrmd]

C0-1: something you read about in text books but never need to do.

I disagree about that one. I do this fairly often for migraines if C2-3-4 facets aren't completely curative and its been quite successful.

 

[bedrock]

C1/2: Injections, either C2 root block or intra-articular C1/2 don't provide lasting relief.

Beg to differ on that point. I have a few patients that get 4-6 months of relief after a C1-C2 injection. I certainly don't get that with everyone, but there are a few that do quite well and it's keeping them out of the surgeons hands for another decade.

 

[melancholy]

There must be over 1000 years of pain experience on this forum. What have you guys found to work best, if anything, for HA, especially those intractable migraines.

For tensions I used a lot of TPIs
I do a lot of GONB, ATNB, and SONB
CMBB, especially of 3rd occipital nerve has worked at times
Waldman prefers CESI and TCA
I've only done a small amount of Botox for HA

I've also cut out my fluorescent lamps and replaced with full spectrum lighting. The office is darker but has a much calmer vibe to it.

What's your experience?

Sorry to bring up an old thread.

Wondering if anyone is aware of an SDN Headache sub-forum group? I don't see one under Neurology. I do think Headaches are important to share information about given how much disability they can cause and resources they can use up. Any thoughts?

 

[pastafan]

Come on down. We've had a few folks visit for a few days at a time. My practice is an open book.

Do it. Fun and well worth your time.

 

[Aether2000]

I have done about 20 OA blocks....usually useless and ineffective. AA books are useful if there is rotational pain produced over the inferior occipital and upper neck

Sent from my SM-G930U using SDN mobile

 

[melancholy]

That headache conference I went to in San Diego had a lot of experts from east coast and mid-west where there seem to be a lot of headache specialty clinics and inpatient units . It was actually quite enlightening and I'm glad I went, esp since our system may not do a great job of managing these patients and so they are free to roam primary care, ED, and occasionally the pain departments.

It seemed like there was a lot of emphasis on doing away with medication overuse headaches (MOH). that was repeated over and over and over again for good reason.

Narouze was there, but overall all the headache specialists kept on talking about GONBs, SPGs, TPIs, and some facet procedures for headaches of all kinds, even chronic migraines that often have other overlapping pain conditions. I attended this workshop by Sphenocath who has some simple introducer to drop some local anesthetic to the sphenopalatine ganglion and supposed to have a better "hit rate" than using a long swab as confirmed by fluoro. Seems pretty interesting although the literature seems limited for chronic migraines as well... mostly industry related stuff. (although for cluster headaches it is used often for this).

There just seemed to be sort of an "art" and method to the madness of sorting out these complex headache patients and it was good to actually get some things straight in my head even though there was a lot of information to try and take in.

I guess that's why I'm wondering if there's a headache forum somewhere to discuss in further detail or perhaps this is it?