Temmuz 2023 – Sayfa 2 – Specialist Dr. Turan Poyraz – Brain and Nerve Diseases Specialist

NERVE BLOCKAGES

18 Temmuz 2023/0 Yorumlar/in Genel/tarafından drturan_pyrzawp

In cases of Migraine, Cluster, Trigeminal Neuralgia and Tension Type Headaches, in cases resistant to drug treatment or in cases where drug treatment cannot be used (pregnancy etc.), nerve blockade methods can be used.

What is referred to as nerve blockade is based on the principle of administering a number of drugs (lidocaine, bupivacaine, triamcinolone, physiological serum etc.) to the nerves that cause pain attacks and are thought to be connected to the pain centers in the brain (Trigeminovascular and trigeminocervical system) using special injection techniques. Nerve blocks are interventional procedures.

Blockade can be applied to many nerves associated with head and facial pain (greater occipital nerve, lesser occipital nerve, supraorbital nerve, infraorbital nerve, supratrochlear nerve, auriculotemporal nerve, mental nerve etc.). More than one nerve can be blocked at the same time.

The most common is the greater occipital nerve blockade (GON = Greater Occipital Nerve). This nerve is directly related to the Trigeminovascular/Trigeminocervical system.

GON blockade:

Although its popularity has increased in recent years, its application history dates back to the 1940s. It can be applied as both an attack and a preventive treatment for migraine headaches. It is an effective and safe method for the treatment of migraine patients who are resistant to drug treatment or who cannot use medication due to various reasons such as pregnancy.

How is it applied?

Drugs applied to the greater occipital nerve with a special technique, sometimes (not necessarily) with ultrasound guidance, at neuroanatomically determined points, block the reversible sodium channels in the nerve fibers. Thus, the formation of pain stimuli in the nerve and vascular centers to which the nerve is connected, especially in the Trigeminocervical systems, and which are related to migraine headaches, is prevented. This effect also has a REGULATORY effect on the mechanisms that create migraine pain, which we call NEUROMODULATION.

The nerve, whose neuroanatomical localization is made with a special injection technique, is blocked by injecting a mixture of local anesthesia and physiological serum.

The injection can be made unilaterally or bilaterally.

Since local anesthesia is applied, there may be temporary numbness, matting or loss of sensation in the applied area.

How long is the application?

The procedure is completed within 1-2 minutes after the preparations are completed.

It can be applied weekly for 4-6 weeks. Afterwards, the application is continued monthly.

Since it is not only an attack treatment but also a preventive treatment, the application should be repeated at the times determined by the neurologist.

Does it have any side effects?

Although it is a very reliable method, some rare side effects can be seen.

As with all injection methods, infection at the injection site (if the area is not cleaned sufficiently), subcutaneous bleeding, secondary syncope/fainting or fainting due to injection, low blood pressure, nausea, palpitations may occur.

Local anesthetics can rarely cause heart rhythm disorders, allergic reactions and hypersensitivity reactions. Therefore, it is recommended to apply in a clinical environment.

In cases where steroids are applied, thinning of the scalp and hair loss may be observed in the application area.

Indications are primarily MIGRAINE type resistant headaches;

Occipital neuralgia

Cervicogenic headache

Cluster headache

Headaches due to muscle spasm

Diseases seen in intra-segmental structures

Regional cancer pain

In neural therapy applications, for interference areas

Contraindications (situations that should not be performed)

Those with bleeding disorders

Those using blood thinners (doctor decides according to the patient)

In the area to be treated or in the presence of systemic infection

In case of regional metastasis

CLUSTER HEADACHE

17 Temmuz 2023/0 Yorumlar/in Genel/tarafından drturan_pyrzawp

The most severe of all headaches is CLUSTER headache. It is more common in men and especially in smokers. Its most important feature is that it is short-term. The pain usually lasts between 15 minutes and 3 hours. The pain is always on the same side and is unilateral. The pain is noticeable around the eyes, and can be reflected to the face, forehead and sometimes to the temple. During the pain, there may be redness in the eyes, watering, drooping eyelids, nasal congestion and runny nose on the painful side. The pain is in the form of a gouging, stinging and obsessive. It can recur up to 8 times a day. Attacks usually occur at night and can recur during the day. All pains are severe. There are two types: episodic and chronic. In the most common episodic type, the pain lasts for a few weeks to a few months during a certain period of the year (for example, in the spring), and sometimes the pain may not be seen for several years during the rest of the year. Being able to relieve it with oxygen therapy is an important distinguishing feature. It is a type of headache with a very high success rate in pain control with correct diagnosis and treatment.

In cluster headache patients, reducing or stopping alcohol and cigarette consumption, which are known to trigger attacks, especially during cluster periods, staying away from closed, stuffy places where smoking is done, choosing places with clean air and cool air, and avoiding daytime sleep are simple but important precautions that can be taken. Alcohol, nitroglycerin, exercise, and high ambient temperature are known precipitants of acute cluster attacks. In most patients with CBA, an acute attack is triggered within an hour after alcohol consumption (in migraineurs, it is triggered within a few hours). Alcohol triggers attacks during a cluster period, but it is not triggered in remission. Allergies, food sensitivities, hormonal changes, and stress do not have a significant attack-precipitating effect.

In cluster headache patients, reducing or stopping alcohol and cigarette consumption, which are known to trigger attacks, especially during cluster periods, staying away from closed, stuffy places where smoking is done, choosing places with clean air and cool air, and avoiding daytime sleep are simple but important precautions that can be taken. Alcohol, nitroglycerin, exercise, high ambient temperature are known precipitants of acute cluster attacks. In most patients with CBA, an acute attack is triggered within an hour after alcohol consumption (in migraineurs, it is triggered within a few hours). Alcohol triggers attacks during a cluster period, but not in remission. Allergies, food sensitivities, hormonal changes, and stress do not have a significant attack precipitating effect.

Attack treatment

Oxygen therapy
5 HT1B/D agonists (sumatriptan, zolmitripan)
Other treatments (octreotide, lidocaine)

Prophylaxis treatment

Short-term (transitional) prophylaxis
Corticosteroids
Ergotamine preparations
5 HT 1B/D agonists

TENSION TYPE HEADACHE

17 Temmuz 2023/0 Yorumlar/in Genel/tarafından drturan_pyrzawp

Tension headache is the most common of all primary headaches. It is also the most common neurological disease worldwide. In a Danish study, the incidence of frequent episodic tension headache and chronic tension headache was found to be 14.2 per 1000 people. The incidence is 2.6 times higher in women than in men. The lifetime prevalence varies between 44-86%. Risk factors include, in addition to being female, low education level, inadequate sleep, physical and mental fatigue, and depression. It comes after migraine in the order of seeking medical attention. This is because patients with tension headache are less likely to seek medical help. Any secondary headache may meet the diagnostic criteria for tension headache. The location of tension headache is variable. Patients often complain of a pain that wraps around the entire head as if there were a tight band. In contrast, the pain can also be felt in the forehead, back of the head, or neck. Headache is usually bilateral and its character is mostly non-throbbing and compressive, pressing. In most patients, the headache is not relieved with moderate severity, and it is rarely seen to be aggravated by daily physical activities. It is not expected that tension headache will be accompanied by symptoms such as being disturbed by light, nausea and/or vomiting. These reasons are referred to as “asymptomatic headache”. There may be patients who say that they are disturbed by sound during the headache. Tension headache occurring less than 15 days a month is considered episodic, and tension headache occurring 15 or more days a month and continuing for at least 3 months is considered chronic. In some patients diagnosed with episodic tension headache, migraine without aura may be valid, and in some patients diagnosed with chronic tension headache, chronic migraine may be valid. Palpation technique is used to determine pericranial muscle sensitivity, which is important in determining the subcategories. Treatment is divided into drug, non-drug and interventional treatment.

Preventive treatment; o If it occurs more frequently than two days in the patient,
o If the headache lasts longer than 4 hours,
o If it causes limitations in daily life activities,
o If there is excessive use of attack treatment drugs,
o If there is sensitivity or contraindication to the drugs used in the attack, it is necessary.
Tension headache, also known as nervous headache, is felt throughout the head but mostly starts from the nape of the neck, is mild, compressive/blunt, is not accompanied by nausea or vomiting, does not increase with movement, and can last much shorter than migraine pain, or can last for weeks, months and sometimes years without interruption. Tension-type headache and migraine attacks that can be triggered by stress can often be confused. However, it is a type of pain that has a low rate of physician visits.

NERVE BLOCKAGES

CLUSTER HEADACHE

TENSION TYPE HEADACHE

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