Abstract ID: A5
Abstract Title: Interruption of trigeminovascular system activation and IHS classified headaches with intramuscular C-7 spinous process bupivacaine injections
Poster Type: Either
ABSTRACT BODY
Introduction: We present what appears to be a highly effective cervical injection technique that consistently and rapidly relieves a variety of headaches classified according to International Headache Society (IHS) criteria.
Background: In 1996, the first author recognized that the injection of anesthetic into the paravertebral musculature approximately 1 inch lateral to the sixth or seventh cervical spinous process consistently relieved headaches as well as their associated symptoms and allodynia. This therapeutic technique has been applied successfully in the management of headaches for hundreds of patients in a private pain practice and emergency department setting. The observed headache and pain relief most likely results from a central pain-modulating mechanism that appears to involve the trigeminovascular system and spinal pathways.
Materials and Methods: A representative case series of headache patients who experienced symptomatic relief following paraspinous intramuscular injection with bupivacaine are presented. With the patient in a seated position, a 1.5 inch 25 gauge needle is used to inject 1.5 mL of 0.5% bupivacaine HCL bilaterally into the paraspinous musculature of the lower cervical spine. The needle is inserted at least one inch into the paravertebral spinal musculature 2 to 3 cm lateral to the spinous process of the sixth or seventh cervical vertebrae. The needle is inserted perpendicular to the transverse plane of the lower dorsal neck and parallel to the examination table. Patient pain relief was documented using a numeric descriptor pain scale.
Results: The patients described in this representative case series experienced rapid relief of headache pain and allodynia. Both acute and long-standing headaches are quickly terminated. In addition to relief of headache pain and allodynia, this lower cervical intramuscular injection technique rapidly alleviates associated signs and symptoms of nausea, vomiting, photophobia, and phonophobia. In the majority of patients pain relief is complete and persistent.
Discussion: Our clinical experience demonstrates that lower cervical intramuscular anesthetic injections are an effective treatment for a wide spectrum of headaches. Headache relief experienced by our patients may reflect activation of a central pain suppression mechanism or the blocking of peripheral sensitization with subsequent interruption of central sensitization. Based on the rapid and complete deactivation of the trigeminovascular system following these injections, the trigeminal system appears to be involved.
References: Mellick GA, Mellick, LB. Regional head and face pain relief following lower
cervical intramuscular anesthetic injection. Headache 2003;43:1109-1111
ATTACHED FILES
Reg Anesth Pain Med 2004; 29(2):A5