Relief of Secondary Headaches with High Thoracic Erector Spinae Plane Block

Abstract

Nadia Hernandez,1 Grace Guvernator,1 George Ansoanuur,2 Michelle Ge,3 Precious Tabansi,1 Thanh-Thuy Le,1 Salameh S Obeidat,4 Johanna de Haan1 1Department of Anesthesiology, Division of Regional Anesthesiology and Acute Pain Medicine, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX 77030, USA; 2Department of Neurology, Division of Trauma, Concussion and Sports Neuromedicine, University of Florida College of Medicine, Gainesville, FL 32610, USA; 3Department of Anesthesiology, Division of Chronic Pain Management, McGovern Medical School, Houston, TX 77030, USA; 4Department of Anesthesiology, Beth-Israel Deaconness Medical Center, Harvard Medical School, Boston, MA, USACorrespondence: Johanna de Haan Tel [phone]Email [email protected]: Intractable headaches can be debilitating, often leading to significant distress, prolonged medical treatment, and unanticipated hospital admissions. There have been significant advances in the treatment of primary intractable headaches such as migraines, tension headaches, and cluster headaches beyond medical management. Treatments may now include interventional strategies such as trigger-point injections, peripheral nerve stimulators, or peripheral nerve and ganglion blocks. There are few studies, however, describing the use of interventional techniques for the management of intractable secondary headaches, including those attributed to injury or infection. A new regional anesthetic technique, the erector spinae plane (ESP) block, was initially used for neuropathic thoracic pain. ESP block has since been reported to provide acute and chronic pain relief of the shoulder, spine, abdomen, pelvis, thorax, and lower extremity. Additionally, there has been one case report to describe the use of the ESP block in the treatment of refractory tension headache. We report four cases of effective analgesia for intractable secondary headache resistant to medical management with high thoracic ESP blocks. In each case, the ESP block provided instant pain relief. We suggest that the findings of this case series indicate that the ESP block may be a useful intervention in patients with severe secondary headache or posterior cervical pain where conventional therapies have limited success, though more studies are necessary.Keywords: erector spinae plane block, refractory headache, head pain, neck pain, scalp pain, craniotomy pain

Keywords

• erector spinae plane block
• refractory headache
• head pain
• neck pain
• scalp pain
• craniotomy pain