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ASA: Atypical Headache Pain Responds to Deep Cervical Plexus Block By Jill Stein SAN FRANCISCO, CA -- October 21, 2003 -- Deep cervical plexus block may effectively treat refractory headache pain related to reflex sympathetic dystrophy, according to preliminary results released here on October 13th at the 2003 Annual Meeting of the American Society of Anesthesiologists. The findings are drawn from a series of 9 patients, and were reported by Michael Goldberg, MD, University of Medicine and Dentistry of New Jersey, Camden, United States. All patients had a history of brachial plexus traction injury, and presented to the university's pain clinic for deep cervical plexus block in an effort to relieve their headache pain. Patients had undergone a comprehensive evaluation by a neurologist after other commonly used treatments for headache had failed, including anticonvulsants, typical narcotics, and non-steroidal anti-inflammatory drugs. Block was performed under fluoroscopic guidance at the C2-3 level after identification of the deep cervical plexus in the lateral recess with injection of radio-opaque dye. Block needles were advanced to the lateral recess with the fluoroscope. Once located appropriately, 7 ml of 0.5% bupivacaine with 40 mg of depomedrol was injected. Both right- and left-sided blocks were performed, but never bilaterally, because of the potential for complications. Overall, the 9 patients had a total of 37 blocks. Patients rated 92% of 37 blocks as being effective. In addition, the 10-point Visual Analogue Scale (VAS) decreased by a mean of 5.5, with a range of decrease between 8 and 3. Two patients remained pain-free for 4 months, after which they requested an additional block. "Patients could return for another block if their pain recurred," Dr. Goldberg explained. "These patients are very attuned with what's going on with themselves." While Dr. Goldberg presented data on only 9 patients at the ASA meeting, he said he has thus far performed a total of about 150 blocks in 18 patients with refractory C2-C3-induced headaches. Pain diaries in his patients have also demonstrated a reduction in the need for pain medications. [Study Title: Deep Cervical Plexus Block To Treat Refractory C2-C3 Induced Headaches: Abstract A-982] E-mail this page to a friend or colleague! To print, use this version