Nerve and ganglion blocks in the management of headache disorders: a narrative review

Abstract

Background and Objective: Headaches, facial pain, and related entities form a significant source of pain, morbidity, and reduced quality of life for the general population worldwide. Medications form a large component of medical management of many headaches. However, various systemic and other factors may preclude the use of medications. Some patients may be refractory to the conventional methods of management. In a selected group of these headache cases, various peripheral nerve blocks and nerve stimulation can significantly positively affect the diagnosis, prognosis, and quality of life of the patient. In this article, we reviewed the evidence, indications, clinical anatomy, landmarks, techniques, risks and adverse effects of nerve and ganglion block procedures that have been employed for a selected group of patients. Methods: The search for this narrative review was performed between November 1st, 2021, and January 20th, 2022. The databases searched included PubMed, Ovid, Science Direct, and textbooks on pain management. The search terms included nerve blocks, headaches, pain management, migraine, individual pain entities, individual nerve blocks, and ganglion blocks. The complete articles written in the English language were retrieved. Only articles published in English between 1992 and 2022 were included. Exclusion criteria included articles other than in English; articles published prior to 1992 and articles whose complete published form were not available. Key Content and Findings: This literature contains nerve anatomy specific to the orofacial region, it’s distribution, innervation, nerve block technique, pharmacology and adverse effects of specific nerve blocks used to manage headache disorders. Conclusions: Nerve blocks appear in the literature as an accepted technique aiding in the diagnosis, prognosis determination, pain relief and management of headache disorders. The nerve blocks provide considerable improvement in the quality of life of patients affected by headaches. These blocks can greatly enhance accurate diagnosis, thereby potentially preventing difficulties in diagnosis and enabling the clinician in succinct pain management. There is a need for further retrospective and prospective studies exploring the efficacies of various types of nerve blocks as compared to other conventional modalities in the management of headache disorders.