Headache and Migraine Injections

Botox is a drug that is made from a toxin produced by the bacteria that causes botulism. When the toxin is purified and injected around pain-producing tissues, it blocks chemicals that are involved with pain signaling. This results in reduced pain activation in the brain, so the patient feels relief.

Botox is approved in adults with chronic migraines. Migraine headaches are considered chronic when a person has 15 or more headache days per month. We use the same criteria in children to determine which patients may benefit from Botox injections.

The first Botox treatment may take about 20 to 30 minutes. The doctor uses a small needle to inject small amounts of medicine into the muscles of the head and neck. A single treatment session usually includes 31 injections. Botox injection sessions are typically done every 10 to 12 weeks, and benefits may wear off after around three months.

Patients should continue taking their regular medications, as it can take up to six months to achieve the maximum benefit from these injections. The most common side effects include sore neck and headache. Your pediatric neurologist will discuss side effects with you and your child in more detail.

An occipital nerve block is an injection that is used to block a pain signal along a nerve. The solution is usually a combination of a steroidal anti-inflammatory drug and a local anesthetic.

Patients with pain at the back of their head or tenderness over the occipital nerves at the back of the head tend to respond best to this type of injection treatment.

During a nerve block treatment, your doctor will use a small needle to inject a pain-relieving solution into the area around the nerves at the base of the skull. The needle insertion is not painful, but there may be temporary discomfort when the solution is injected. Pain relief may occur within 15 minutes of the injection, and the relief can last for several days or even months. Common side effects include soreness at the injection site or temporary numbness around the nerves.

The supratrochlear nerve is located in the forehead next to the supraorbital nerve. These nerves are a continuation of the frontal nerve, which contribute to pain in the frontal region of the forehead and above the eyes. Patients who come in with a history of chronic headaches, cluster headaches and migraines may benefit from a supratrochlear and supraorbital nerve block injection as the medication in the injection reduces inflammation of the supratrochlear and supraorbital nerves. The medication also reduces pain impulses to the brain to alleviate unwanted pain.

Before the injection is given, a local anesthetic will be applied to the area to ensure your child remains comfortable throughout the treatment. This anesthetic may be lidocaine or bupivacaine. Please let the provider know if your child has had an adverse reaction to either of these anesthetics in the past.

Once numb, the provider will cleanse the treatment area with an antiseptic solution and administer the nerve block medication via injection. Many of our patients can feel relief from their nerve pain within just minutes of treatment.

Risks associated with nerve block injections are generally low; however, minor risks include infection, bleeding and pain at the injection site.

It’s important to let your provider know if your child is currently taking any blood thinning medications or if your child has any active infections as these conditions may require the procedure to be postponed.

The sphenopalatine ganglion (SPG) is a bundle of nerve cells that is closely linked with the main nerve involved in headache disorders. This nerve is called the trigeminal nerve. The SPG is located just behind the nose and is responsible for common sensations including pain, tearing and congestion.

The SPG plays a large role in cluster headaches and migraines, as it contains connections to the brainstem where these headaches may begin. As the migraine or cluster headache begins to affect the body, pain signals pass through the SPG, causing our patients a great deal of discomfort. The sphenopalatine ganglion nerve block stops this transmission of pain by administering anesthesia to the SPG and associated nerves.

The block will be administered directly to the collection of nerves in the SPG. This treatment is typically minimally invasive and does not require any needles. Rather, the block is administered through a catheter placed in the nose.

A numbing agent will likely be used throughout the treatment process. Most patients find the treatment is comfortable with mild sensations of pressure or feeling like they have to sneeze.

Risks associated with an SPG block are generally minimal. Minor risks include infection, bleeding from the nose, pain in the treated areas and light-headedness. Side effects generally resolve on their own within a few hours of treatment.

It’s important to let your provider know if you have any active infections or have a history of nasal surgery as these conditions may require the procedure to be postponed.

If you have additional questions about headache and migraine treatments, please contact our team at 512-494-4000, or book an appointment online.