Injection Therapies (Trigger Point and Nerve Block Injections)

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Injection treatments offered at Neurology Consultants of Nebraska include Botox injections, trigger point injections, and occipital nerve blocks.  We plan to add the capacity to offer Sphenocath sphenopalatine ganglion blocks in the future.  This post will focus trigger points injections and occipital nerve blocks.

Trigger point injections are localized injections of numbing medication (lidocaine and/or marcaine) and sometimes steroid medication (kenalog or triamcinolone), into areas of muscle pain or muscle spasm.  Commonly, 3 or 4 small injections are given, at the same time, to treat adjacent areas of muscle or muscle spasm. Trigger point injections are used to treat a variety of different types of muscle pain, such as acute injuries, myofascial pain, neck pain, fibromyalgia syndrome, and related conditions. In the case of muscle pain conditions, trigger point injections may be used for acute worsening of muscle pain, when medications and/or physical therapies, by themselves, are not adequate.  Trigger points are particularly helpful when the pain is localized to a single muscle or group of muscles.

Occipital nerve blocks are similar injections that are placed at the original of the occipital nerves, which is located at base of the skull, at the junction between the head and the neck.  Usually, two injections are given: one on the left, and one on the right.  Occasionally, a single injection may be given, to treat head or neck pain that is only on one side. Occipital nerve blocks are used to treat a variety of headache conditions including occipital neuralgia, cervicogenic headache, cluster headache, and migraine. In the case of headache conditions, occipital nerve blocks are useful for acute headache that persists, despite appropriate medical therapy.  This may include status migrainosus (i.e. acute migraine for the last 72 hours), acute cluster headache, occipital neuralgia (i.e. shooting pain coming from occipital nerves), or acute worsening of cervicogenic headache (i.e. headache originating from neck pain).

Any patient with the above conditions is a good candidate for injection treatment, at the appropriate time.  You should not receive injection if you are allergic to any of its components.  If you are on anti-coagulation then it may not be appropriate to receive injection, depending on the location and depth of injection, as there would be increased risk of bleeding and bruising.  Your doctor will discuss risks and benefits of individual treatment, at the time of treatment.

Injection therapies can provide substantial relief of pain, within just a few minutes of treatment.  The duration of benefit can last anywhere from several hours to a few weeks.  The medication does wear off, so the benefit does not last forever.  Injection treatments are not guaranteed to work, but there is a good chance of success when they are given in the right location, at the right time.  The most common side effects are pain at the time of injection, and short-term pain or bruising, after injection. Occipital nerve blocks commonly cause numbness to spread across the back of the neck, across the scalp extending to the top of the head, and sometimes forward to the ears or corners of the jaws.  This numbness is to be expected and is a beneficial effect of treatment.

Injection therapies are covered by most insurance plans, but coverage varies.  Occasionally procedures may require pre-authorization by your insurance.  Our office will verify your insurance benefits before proceeding with treatment. The above injection therapies are offered by all of the physicians at Neurology Consultants Nebraska.

Scott Goodman, M.D.