Novel Interventional Nonopioid Therapies in Headache Management

  • Omar Viswanath
  • Roxanna Rasekhi
  • Rekhaben Suthar
  • Mark R. Jones
  • Jacquelin Peck
  • Alan D. Kaye
Other Pain (A Kaye and N Vadivelu, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Other Pain

Abstract

Purpose of Review

Headaches encompass a broad-based category of a symptom of pain in the region of the head or neck. For those patients who unfortunately do not obtain relief from conservative treatment, interventional techniques have been developed and are continuing to be refined in an attempt to treat this subset of patients with the goal of return of daily activities. This investigation reviews various categories of headaches, their pathophysiology, and types of interventional treatments currently available.

Recent Findings

Injection of botulinum toxin has been shown to increase the number of headache free days for patients suffering from chronic tension-type headaches. Suboccipital steroid injection has been demonstrated as a successful treatment option for patients suffering from cluster headache. Occipital nerve stimulation (ONS) has been described as a treatment for all types of trigeminal autonomic cephalgias. Percutaneous ONS is a minimally invasive and reversible approach to manage occipital neuralgia performed utilizing subcutaneous electrodes placed superficial to the cervical muscular fascia in the suboccipital area. Radiofrequency lesioning is another commonly used treatment in the management of chronic pain syndromes of the head and neck. If a diagnostic sphenopalatine ganglion block successfully resolves the patient’s symptoms, neurolysis can be employed as a more permanent solution.

Summary

Although many patients who suffer from headaches can be treated with conservative, less-invasive treatments, there still remains at present an ever-increasing need for those patients who are refractory to conservative measures and thus require interventional treatments. These procedures are continually evolving to become safer, more precise, and more readily available for clinicians to provide to their patients.

Keywords

Headache Botulism toxin Sphenopalatine ganglion block Suboccipital steroid injection Occipital nerve stimulation Trigeminal autonomic cephalgias 

Notes

Compliance with Ethical Standards

Conflict of Interest

Omar Viswanath, Roxanna Rasekhi, Rekhaben Suthar, Mark Jones, Jacquelin Peck, and Alan D. Kaye declare no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Omar Viswanath
    • 1
  • Roxanna Rasekhi
    • 2
  • Rekhaben Suthar
    • 3
  • Mark R. Jones
    • 1
  • Jacquelin Peck
    • 4
  • Alan D. Kaye
    • 5
  1. 1.Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonUSA
  2. 2.Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami School of MedicineJackson Memorial HospitalMiamiUSA
  3. 3.Department of AnesthesiologyMt. Sinai Medical Center of FloridaMiami BeachUSA
  4. 4.Department of AnesthesiologyJohn Hopkins All Children’s HospitalSt PetersburgUSA
  5. 5.Department of AnesthesiologyLouisiana State University Health Sciences CenterNew OrleansUSA

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