Minimally invasive interventions for headaches

On the whole, Migraine and Tension-type headaches represent almost ۸۵ % of head and facial pains. Theconvergence of somatic and autonomic neural pathways in head and neck, called the trigeminocervical complexis accounted responsible for the pain transmission of these headaches. There are many interventional andmedical treatments for these patients. Interventional procedures are reserved for patients not responding tomedical therapies or who cannot tolerate these medications because of side effects and comorbid medicalconditions. These procedures can be classified into invasive and minimally invasive techniques. The invasiveinterventions include Gasserian ganglion block or neurolysis, Sphenopalatine ganglion block or neurolysis,atlantoaxial joint injection, third occipital nerve block and ablation, cervical facet medial branch block andablation. These procedures are invasive, need complete vital sign monitoring in the operation room and alsodegrees of light to deep sedation. The minimally invasive techniques can be done in an office-based setting.The trigeminocervical complex terminal branches are superficial nerves that can be blocked with long actinglocal anesthetics with corticosteroids. These are the supraorbital, supratrochlear, lesser and greater occipitalnerves. These nerve blocks exhibit both abortive and prophylactic benefits. The sphenopalatine ganglion canalso be blocked transnasally with cotton tipped applicators soaked in lidocaine and if repeated may haveprophylactic role in treatment of chronic migraine. Onabotulinum toxin type-A injection is the only approvedinterventional treatment for chronic migraine and is being increasingly used to reduce the frequency and alsoseverity of migraine attacks and the need for abortive drugs.