Migraine and headache

There is no special preparation. A few things help us plan the treatment.

Bring

• Your headache diary, or a rough count: headache days per month over the last three months, and how many of those were severe.
• A list of your current medications, including what you take when a headache starts and anything you take to prevent them.
• What you have already tried, and how well each thing worked.

Keep taking

• Your usual headache and migraine medications, unless we have told you otherwise.
• Prescribed blood thinners. Do not stop them. Tell us and we plan around them.

Tell us before

• If you are pregnant or breastfeeding.
• Any allergy to a numbing medication or to steroids.
• If you have diabetes. A steroid in a nerve block can raise blood sugar for a day or two.
• Any rash, cut or infection where the injection would go.
• Previous Botox or nerve blocks for headache: when, and how long relief lasted.

The day itself

• Eat beforehand.
• Clean hair and skin, with no hair products at the back of the head or on the forehead.
• Most people drive themselves home. For a first nerve block, have someone you can call if you feel lightheaded.

The first four hours

• Stay upright.
• Do not rub or massage the injection sites. Forehead, head, neck and shoulders.
• No hard exercise, sauna or hot tub for the rest of the day.

The first weeks

• Mild headache, or neck and shoulder soreness, for one to two days is common.
• Prevention builds over two to four weeks. Some people need two treatment cycles for the full benefit.
• Keep a headache diary. It is how we judge the result and adjust the next session.
• Keep taking your usual headache medications.
• Repeats every twelve weeks.

Occipital is the back of the head. Supraorbital is above the eyebrow. The instructions below apply to both.

The first day

• Numbness over the treated area for a few hours is expected.
• Relief can start within minutes. If a steroid was included, its longer effect builds over a few days, so a headache can briefly return when the numbness wears off.
• Soreness or a small bruise for a day or two. A cold pack, ten minutes at a time, helps.
• Take it easy for the rest of the day. Showering is fine.
• If you have diabetes and a steroid was used, check your blood sugar more often for a day or two.

After that

• Keep a headache diary, noting how long the relief lasts. That is what decides when, or whether, to repeat the block.
• Keep taking your usual headache medications.