Primary headaches (tension, migraine, and cluster) are common in the reproductive population. Headache treatment during pregnancy is made more difficult by clinician discomfort with treatment options, concern for masking secondary headaches, and fear of potential fetal effects from headache treatments. As a result, treatment of headache disorders is often delayed during pregnancy.
Occipital nerve block is a well-established treatment for tension and migraine headache in the nonpregnant population with both abortive and prophylactic treatment benefits. Occipital nerve block is a safe, commonly performed procedure that involves a subcutaneous injection of local anesthetic with or without a steroid component bilaterally into the area around the occipital nerves. A recently published randomized trial assessed the efficacy of occipital nerve block compared with standard care of an oral cocktail of acetaminophen and caffeine for the treatment of acute headache in pregnancy.
In this randomized controlled trial of pregnant people, treatment with occipital nerve block resulted in lower visual pain scale scores at 1 hour and more rapid turnaround in maternal emergency room. The study found no difference at 2 hours, but the reduction in visual rating scale scores at 1 hour is encouraging. The study suggests that occipital nerve block is a quick-acting, effective treatment for acute headache in pregnancy. Furthermore, in an emergency care setting or for refractory headache, occipital nerve block has some improved outcome metrics compared with standard care. Given the multiple limitations that pregnant people face in acute headache treatment, occipital nerve block should be considered as a primary, secondary, or alternative acute headache treatment in pregnancy. The trial supports the option of occipital nerve block use for pregnant patients.
At MCHN/Nervana, we have used occipital nerve blocks with success. Call for an evaluation to determine if this treatment is appropriate for you.
–Alice Wong, NP
Reference: Bushman, Elisa T. MD; Blanchard, Christina T. MS; Cozzi, Gabriella D. MD; Davis, Allison M. MD; Harper, Lorie MD, MCSI; Robbins, Lindsay S. MD, MPH; Jones, Benjamin MD; Szychowski, Jeff M. PhD; Digre, Kathleen B. MD; Casey, Brian M. MD; Tita, Alan T. MD, PhD; Sinkey, Rachel G. MD. Occipital Nerve Block Compared With Acetaminophen and Caffeine for Headache Treatment in Pregnancy: A Randomized Controlled Trial. Obstetrics & Gynecology 142(5):p 1179-1188, November 2023. | DOI: 10.1097/AOG.0000000000005386