Efficacy of Nerve Blocks for Episodic Migraine

Prior treatment

• Women who report being currently pregnant or lactating or are of child-bearing potential or are likely to become pregnant during the medication phase and are unwilling to use a reliable form of contraception. Acceptable forms include:
  • Hormonal methods, such as birth control pills, patches, injections, vaginal ring, or implants
  • Barrier methods (such as a condom or diaphragm) used with a spermicide (a foam, cream, or gel that kills sperm)
  • Intrauterine device (IUD)
  • Total hysterectomy or tubal ligation
  • Abstinence (no sex)
• Previously received peripheral nerve blocks (PNBs)
• Currently receiving Botox for migraine prophylaxis
• Started on new medication in the prior two months with known migraine-preventive efficacy or planning to start any new medication during the study
• Currently using opiate medications for pain
• History of drug or alcohol abuse within the prior two years
• Diagnosis of medication overuse, cervicogenic, post-traumatic, or cluster headaches or history on pre-enrollment questionnaire of cluster headache symptoms.

Other illness

• Allergy or documented contraindication to amide anesthetics (bupivacaine, lidocaine, ropivacaine, prilocaine, mepivacaine, etidocaine or levobupivacaine) or corticosteroids
• Have unstable medical or surgical diseases that could impair participation in this study
• History of craniotomies, burr holes, skull fractures and/or have open skull defects
• Active skin or soft tissue infection overlying injection sites

Other

• Headache in cheeks (infraorbital nerve distribution) in addition to scalp distribution.
• Currently anticoagulated
• Patients with implanted nerve stimulators or shunts
• Phobia of needles

• Suffering from episodic migraines with and without aura occurring at least four times a month but less than 15 times a month at a severity of 5/10 pain level or greater.
• Willing to not start or stop any new medication to treat or prevent migraines during the six months of the trial.
• History fits the definition of migraine:
  • Have a history of episodic headache lasting 4-72 hours with at least 2 of the 4 following: unilateral location, pulsating/throbbing quality, moderate-severe intensity, aggravation by/causing avoidance of routine physical activity, and
  • Have a history of at least one of the following: nausea and/or vomiting, photophobia (seek out a dark room during a headache because that feels better), phonophobia (seek out a quiet environment during a headache because that feels better)