Peripheral Nerve Blocks for Headaches

Patients have numerous options for headache management at home, yet when those fail, use of peripheral nerve blocks (PNBs) in the outpatient clinical or emergency department setting can be useful. Peripheral nerve blocks (PNBs) targeting the occipital and trigeminal scalp nerves are increasingly used by primary care and emergency medicine providers for acute headache relief and prophylaxis. The purpose of this article is to provide context, with an overview of epidemiology, diagnostic considerations, and trial evidence, along with procedural guidance for use of PNBs to treat headache disorders in the primary care setting. Despite methodological and outcome heterogeneities amongst randomized controlled trials (RCTs), evidence supports the use of PNBs, particularly greater occipital nerve block (GONB), for both acute headache relief and prophylaxis. It is within the scope of the primary care clinician to provide the option of PNB for appropriate patients. Further RCTs are warranted to define optimal nerve block combinations and procedural standards.