Related Experiment Video
Updated: May 23, 2026
04:06
Minimally Invasive Surgical Decompression of Occipital Nerves
Published on: September 13, 2024
Peripheral nerve blocks: a therapeutic alternative for hemicrania continua
Ángel L Guerrero1, Sonia Herrero-Velázquez, María L Peñas
1Neurology Department, Hospital Clínico Universitario, Valladolid, Spain. gueneurol@gmail.com
Cephalalgia : an International Journal of Headache
|March 23, 2012
Summary
Peripheral nerve blocks and corticosteroid injections offer effective treatment for hemicrania continua (HC) when indomethacin causes side effects. These procedures provided relief for patients with tender supraorbital or greater occipital nerves, or in the trochlear area.
Area of Science:
- Neurology
- Pain Management
Background:
- Hemicrania continua (HC) diagnosis requires a complete response to indomethacin.
- Indomethacin intolerance necessitates alternative treatments, but effectiveness has been inconsistent.
- Peripheral nerve blocks and corticosteroid injections show promise in case reports.
Purpose of the Study:
- To evaluate the effectiveness of anaesthetic blocks of peripheral nerves and trochlear corticosteroid injections in patients with HC.
- To identify potential treatment alternatives for HC patients intolerant to indomethacin.
Main Methods:
- Twenty-two HC patients were assessed in a headache outpatient office.
- Physical examination included palpation of the supraorbital nerve (SON), greater occipital nerve (GON), and trochlear area.
- Nine patients with indomethacin intolerance underwent anaesthetic blocks (GON/SON) or trochlear corticosteroid injections, with four receiving combination therapy.
Main Results:
- Tenderness was detected in at least one of the examined areas in 14 patients.
- All nine patients who received anaesthetic blocks or corticosteroid injections experienced total or partial improvement.
- Symptomatic relief lasted from 2 to 10 months.
Conclusions:
- Anaesthetic blocks of the SON or GON, and corticosteroid injections in the trochlear area, are effective therapeutic options for HC.
- These interventions are particularly beneficial for HC patients exhibiting tenderness in these specific anatomical locations.
- Peripheral nerve blocks and corticosteroid injections represent viable alternatives for managing HC when indomethacin is not tolerated.
Related Concept Videos
01:16Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia
Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
One of the advantages of...
One of the advantages of...
01:27Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacological Actions
Nondepolarizing neuromuscular blockers prevent the membrane depolarization of muscle cells and inhibit muscle contraction. These are usually administered with anesthetics to achieve complete muscle relaxation. Upon administration, these drugs first block the small, rapidly contracting muscles of the face and hands, followed by the larger muscles of the trunk and the intercostal muscles. The diaphragm is the last muscle to be affected.
Although all competitive neuromuscular blockers are designed...
Although all competitive neuromuscular blockers are designed...
01:28Drugs Acting on Autonomic Ganglia: Blockers
Ganglionic blockers inhibit autonomic activity by blocking nicotinic receptors in the autonomic ganglia, suppressing impulse transmission. These blockers lack selectivity between sympathetic and parasympathetic ganglia and are ineffective as neuromuscular junction antagonists. They can be categorized into two groups:
01:30Local Anesthetics: Clinical Application as Surface, Infiltration, and Conduction Block Anesthesia
Depending on the target organ, local anesthetics (LAs) can be administered via various routes. In surface anesthesia, LAs are applied directly to the surface of the skin or mucous membranes. It is widely used for topical skin numbing before venipuncture or minor surgical procedures. Commonly used surface local anesthetics are lidocaine or benzocaine sprays or creams. Surface anesthesia occurs within 5 minutes and lasts for about 60 minutes. One of the main disadvantages of topical anesthesia is...
01:17Nondepolarizing (Competitive) Neuromuscular Blockers: Mechanism of Action
Nondepolarizing neuromuscular blockers induce paralysis by competitively blocking nicotinic acetylcholine receptors at the muscle end plate. Examples include pancuronium, mivacurium, vecuronium, and rocuronium. These quaternary ammonium derivatives are administered intravenously, are poorly absorbed, and are excreted via the kidneys.
Competitive antagonists prevent acetylcholine from binding to its receptor, inhibiting membrane depolarization. Without conformational changes or intrinsic...
Competitive antagonists prevent acetylcholine from binding to its receptor, inhibiting membrane depolarization. Without conformational changes or intrinsic...
01:09Peripherally and Centrally Acting Muscle Relaxants: A Comparison
Skeletal muscle relaxants can target the central nervous system [CNS] to reduce muscle tension or act directly at the neuromuscular junction to induce temporary paralysis. These two classes of muscle relaxants are called centrally acting muscle relaxants and peripherally acting muscle relaxants. They differ in their action, mechanism, administration route, and clinical uses.
Centrally acting muscle relaxants can be further divided into spasmolytic and antispasmodic drugs. Spasmolytic drugs,...
Centrally acting muscle relaxants can be further divided into spasmolytic and antispasmodic drugs. Spasmolytic drugs,...