40 Headache Medicine, v.9, n.2, p.40-41, Apr./May/Jun. 2018
n the last decade physicians have increasingly used infiltrations to treat pain.
(1-8)
In Headache Medicine also the use of infiltrations or nerve block injection at different
anatomic sites is frequently performed.
(6,9)
In general there is a consensus as to where the
needle should be inserted, but the choice of anesthetic and whether it should be used in
combination with corticoid are both still very controversial issues.
(10-13)
In this issue of
Headache Medicine, Karen and coworkers
(14)
describe their experience with 82 patients
over 50 years of age who were treated with infiltration of anesthetic, corticoid or both, in
order to treat headache suffering.
Classically, the supraorbital, supratrochlear, auriculotemporal, greater and lesser
occipital nerves are the target tissue of the infiltration, although the nerve must not be
injured by the needle. The solution injected should be in the environment around the
nerves, in order to block nerve transmission.
Some experts believe that the use of the needle alone, without any injection of
anesthesic drugs or corticoid, is enough to induce an attenuation in the frequency and
intensity of the headache attacks. The control group in the study using botulinic toxin, in
which patients received only the vehicle or placebo, presented a significant improvement
in their headaches. Acupuncture is another classic example of pain treatment using needles.
Curiously, historical data of a native Indian population – the Yámanas – an extinct
prehistorical tribe that inhabited the island of Tierra del Fuego in the extreme south of the
American continent, indicated that they used small branches of prickly plants (chaura,
Pernettya mucronata) to scarify certain areas of the head to treat severe headaches in the
sufferers.
(15)
Thus, a placebo effect must be considered as a possible mechanism
responsible for the attenuation of the pain.
Regarding the technique of infiltration of nerves, the article by Ferreira and
colleagues,
(16)
elegantly shows the supraorital foramen and its anatomical variants, where
the supraorbital nerve reaches the forehead from its intraorbital pathway. This anatomical
reference is very important in the process of infiltration and nerve block in a patient with
incapacitating headache.
REFERENCES
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for Acute Treatment of Migraine Headache: A Large Retrospective Cohort Study. J Am Board Fam Med
2018;31(2):211-18.
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effectiveness differ in chronic migraine patients? Neurol Sci 2017;38(6):949-54.
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Treating headache with a needle in the anatomic spots
Tratar cefaleia com uma agulha nos pontos anatômicos corretos
I
EDITORIAL
Headache Medicine, v.9, n.2, p.40-41, Apr./May/Jun. 2018 41
Marcelo Moraes Valença
Full Professor, Neurology and Neurosurgery, Federal University of Pernambuco, Recife, Pernambuco, Brazil
Editor-in-Chief, Headache Medicine
mmvalenca@yahoo.com.br
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nerve in human. Headache Medicine. 2017;8(4):130-133.
TREATING HEADACHE WITH A NEEDLE IN THE ANATOMIC SPOTS
