New Patient History Form

Migraine Treatment

Available Headache Rescue Options

greater occipital nerve block Greater occipital nerve block

1. Where is the occipital nerve?

The occipital nerve is located at the base of the skull and extends up the back of the head.

2. How are occipital nerve blocks performed?

You will be asked to pull your chair forward so the physician can stand behind you. The physician will mark the area to be injected and clean the area with an antibacterial solution. The physician will pass the needle through the skin and deeper tissues and inject the medication into the area around the occipital nerve.

3. How soon will the treatment help?

The onset of pain relief may be as soon as 15-20 minutes. This is due to the effect of the local anesthetic. Your pain may return in 6-8 hours as the local anesthetic wears off. The effect of the steroid will be felt in 48-72 hours. The steroid should provide longer relief because of its anti-inflammatory effects.

4. Can the occipital nerve blocks be repeated?

If you have relief from of your pain, the injection may be repeated as soon as one week.

5. What are the risks and hazards of this procedure?

As with any procedure, there is the potential for problems. The risks are minimal. Problems that could occur are: Slight bleeding and risk for Infection.

6. How should I care for myself after the injection?

Bedrest is not required. You may resume your normal activities the day of the injection. You may continue your normal diet and medications after the procedure. To relieve any soreness at the injection site, you may apply ice to the site 20 minutes on/ 20 minutes off on the day of the injection. At subsequent times, you may choose to apply ice or heat. Please do not apply either for more than 20 minutes at a time.

Sphenopalatine Ganglion Block

1.What is a Sphenopalatine Ganglion Block?

This procedure is an injection of a numbing agent through the nostrils (one or both) with a simple applicator. The numbing agent works on the ganglion area to provide pain relief for multiple head and facial pain conditions and is performed as an outpatient procedure.The procedure entails low risks and is exceptionally well tolerated by patients.

2.What exactly is the sphenopalatine ganglion?

The definition of a ganglion is a “mass of nerves” and in the case of the sphenopalatine ganglion, represents a nerve bundle that reaches out to the lacrimal gland, paranasal sinuses, palate, and throughout the upper pharynx and nasal cavity. The location of the ganglion is  in a bony cavity called the pterygopalatine fossa, which is deep in the midface and behind the nasal cavity.

Because of such a broad reach that the nerves from the SPG expand to, the ganglion plays a role in causing pain associated with acute and cluster headaches, trigeminal neuralgia, TMJ, RSD, and facial pain.

3.What are the risks of an SPG block?

The risks of sphenopalatine ganglion nerve blocks are very low. With the topical procedure, patients may sustain a bitter taste in the mouth from dripping of the numbing agent down the oropharynx.

Injections maintain a slight risk of infection, along with a slight risk of a nose bleed or temporary lightheadedness.

4. Patient discharge Instructions:

After the 8 minute absorption duration, The patient was discharged with instructions to:

  1. Avoid strenuous activity for 24 hours
  2. Aggressively hydrate with oral fluids
  3. Patient was instructed to contact physician office in the event the migraine condition symptoms are aggravated and reappear.
  4. Maintain pre-operative caffeine consumption patterns for at least one week.
  5. Scheduled a patient follow up appointment in 6 weeks, unless headache or facial pain symptoms return prior to that time frame.

Transcranial Magnetic Stimulation

Migraine is often described as an electrical storm, in which the brain is hyperexcitable with an abnormal response to normal stimuli or triggers. The result can be an excruciatingly painful headache. Clinical research has shown that a brief pulse of energy, such as transcranial magnetic stimulation (TMS), may be effective in interrupting or short-circuiting the progression of migraine.

1.What is TMS Technology

TMS technology has been used for many years to study the brain. The most robust and widely accepted use is in measuring the connection between the primary motor cortex and muscles. TMS is based on the principles of induction—rapidly changing magnetic fields that induce electrical currents. When TMS is applied to the back of the head, a magnetic field of very short duration passes through the skull and tissue non-invasively and without discomfort. The magnetic field induces very mild electrical currents in the brain tissue to excite and depolarize neurons in the brain. This process is thought to interrupt the abnormal electrical activity associated with migraine and cortical spreading depression (CSD).

2.What to expect during TMS treatment:

Using both hands to hold the device against the back of the head, the user presses a button to release a pulse of magnetic energy to stimulate the occipital cortex in the brain, which may stop or lessen the pain associated with migraine headaches preceded by an aura. The pulses may be delivered four times, over fifteen minute intervals.

3.What are the adverse reactions to TMS:

aphasia (inability to speak or understand language) and vertigo (sensation of spinning). Dizziness may be associated with the use of the device, but is also rare.

***Patients must not use the Cerena TMS device if they have metals in the head, neck, or upper body that are attracted by a magnet, or if they have an active implanted medical device such as a pacemaker or deep brain stimulator. The Cerena TMS device should not be used in patients with suspected or diagnosed epilepsy or a personal or family history of seizures. The recommended daily usage of the device is not to exceed one treatment in 24 hours.

4. Discharge Instructions post TMS:

Patient is able to resume all normal activities and may return to school/work.


Trigeminal Nerve

Trigeminal Nerve

Trigeminal Nerve Blocks


The trigeminal nerve is composed of three large nerve branches responsible for sensory and motor skills of the head and face.


The trigeminal nerve block is used to bring relief to patients who suffer with head pain or other facial pain, which may be the result of trigeminal neuralgia, shingles or nerve injury.


A patient may receive IV sedation for this procedure. The skin is cleansed with an antiseptic; then numbed with a local anesthetic. Utilizing a fluoroscope (x-ray guidance), the physician will identify the correct spot for needle placement. A trigeminal nerve block involves the administration of local anesthetic and/or steroid into the nerves of the head and face to block the pain.

4.Length of Procedure:

The procedure takes approximately 10 minutes. The patient will be monitored in the recovery area for approximately 1/2 hour before being discharged.

A patient must make prior arrangements for a ride home following the procedure.