If your regular methods for treating migraines are not keeping you from constant headaches or you have recurring sinus pressure with accompanied unexplained balance, auditory or olfactory symptoms, you may actually have a migraine. If so, you might be a candidate for a migraine block procedure performed by CEENTA ENT physician Mark Abrams, MD, in Rock Hill.

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What ENT conditions could actually be a migraine?

Many ear, nose, and throat conditions present with symptoms that are similar to a migraine, predominantly facial pressure, sensitivity to light or sound, congestion, clear drainage and nausea. These conditions may include:

  • Sinus infections or sinus headaches
  • Earaches
  • Imbalance or vertigo
  • Neck pain and jaw pain

What are typical treatment options for migraines?

After being diagnosed with a migraine, the usual methods of treatment are nonsteroidal anti-inflammatory drugs (NSAIDs), and migraine specific medications along with symptomatic management of nausea. Hydration, increasing protein intake, and getting in a dark environment and actually sleep is helpful during a significant event. These options may have limited efficacy for chronic and severe migraines.

The intranasal migraine block treatment

Using a well-established neurologic procedure, a migraine can be acutely managed by what is called an intranasal nerve block using local anesthesia applied as an office procedure endoscopically to halt the neural input of pain via a needless approach. It is a 10-minute procedure that can be done same-visit, in the office, without sedation with a quick relief and can be diagnostic when the condition is in question. The key is in the scopes, as otolaryngologists we can evaluate the nose and sinuses but also visualize block placement and use the precision of a sinus surgeon to allow for a high level of success.

How does the block work?

The block works very similar to a reset button on a cell phone by "turning off the on button." One of the main triggers for headache is persistent stimulation, particularly pain, to a neurologically strained brain. The input for this information in the front of the skull is the trigeminal nerve which has 3 main branches. Classically, these nerves can be "turned off" by injecting local anesthetic such as lidocaine. Inside the nose, this can be achieved without needles using endoscopically placed cotton to deliver the medication. By doing so, quick relief can be achieved, not only of the pain, but also the drainage, obstruction and other migraine related symptoms such as dizziness, brain fog, ear/jaw/neck pain, and other unusual symptoms such as phantom smells, transient ringing or hearing loss or hemifacial swelling.

By numbing these nerves with a local anesthetic such as lidocaine, the signals for pain, especially migraine headaches, can be blocked for weeks at a time.

How is the migraine block applied?

Your physician will begin by treating your nose to two sprays: a decongestant like Afrin to open up the nasal passages, and lidocaine spray to numb the area during the procedure. After waiting five minutes for both sprays to take effect, your physician will endoscopically apply small pieces of cotton soaked with concentrated doses of lidocaine on top of the nasal lining over the two main targets - the sphenopalatine ganglion (behind the eye, teeth and jaw) and the anterior ethmoidal nerves (forehead).

Diagram of nerves within the nasal cavity related to migraines and migraine blocks

The cotton pieces are kept in place for ten minutes in order for the lidocaine to be absorbed by the nose and subsequently the SPG and anterior ethmoidal nerves. Within five minutes, the block begins to work and interrupts the pain signal that results in migraine headaches.
The result can be striking.

Occipital nerves related to migraine blocks

Occipital blocks:
In addition, posterior neck nerve blocks can also be offered to completely block painful neural input which arises from the back of the head in about 25% of patients. These are called lesser and greater occipital blocks and do involve an injection of local anesthetic - lidocaine followed by bupivaine.

A = greater occipital nerve. B = lesser occipital nerve

All blocks should be covered by insurance.

Scheduling your migraine block treatment at CEENTA

Dr. Mark Abrams offers this game-changing treatment method for migraines at our Rock Hill office. To see if you’re a candidate for this procedure, call 803-327-4000.

Schedule Your Migraine Block Appointment Today

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