A Systematic Review of Anesthetic, Saline and Dry Needling Injections for Headache Patients
DOI:
https://doi.org/10.17140/EMOJ-9-170Keywords:
Headache, Cervical injections, Orofacial pain, Dry needling, Saline injections, Paraspinous injectionsAbstract
Objectives
Earlier literature provided evidence of neck pain relief via cervical trigger point injections with anesthetic agents. However, recent evidence suggests that intramuscular or paraspinal cervical injections with local anesthetic may provide relief for various types of headaches and orofacial pain as well. The primary purpose of this systematic review was to determine whether a cohort of retrospective case studies and randomized controlled trials using paraspinal cervical or intramuscular anesthetic injections were associated with a decrease in headache and orofacial pain.
Methods
A systematic review of the literature was performed to observe the association between headache or orofacial pain relief and paraspinal cervical injections with various pain-relieving agents. Literature searches using the key terms “headaches”, “paraspinous cervical injections”, “neck/intramuscular injections” and “orofacial pain” were performed in PubMed, Google Scholar, and Scopus. We implemented the preferred reporting items for systematic reviews and meta-analyses (PRISMA) format for the systematic review.
Results
Initially, four hundred forty articles were located during the systematic review. Five total articles were selected for review and 435 were excluded because they did not meet search criteria. Another two relevant articles were found during manual searches within references of the systematic review. The seven studies included were retrospective case studies involving patients with headaches or orofacial pain who received paraspinal cervical or other intramuscular injections. A total of 841 patients’ data were tallied from the 7 articles and 683 of those patients received anesthetic injections. Significant pain relief due to intramuscular or paraspinal cervical injections was observed in 83.7% of the patients.
Conclusion
Our systematic review of association between headache or orofacial pain relief and paraspinal cervical injections with various pain-relieving agents demonstrated a frequency of headache and orofacial pain relief of 83.7%. Such a large percentage compared to a robust placebo study provides promising evidence that this treatment may have a therapeutic role in the management of headache and orofacial pain. Despite limitations faced in performing our systematic review, it seems quite clear that pain relief for these headache patients can be attributed to intramuscular anesthetic or dry needling injections. While larger prospective studies should be performed regarding specific location and anesthetic, our systematic review provides additional evidence that anesthetic intramuscular and dry needling injections provide pain relief intension-type headaches (TTH), migraine headaches, cervicogenic headache pain, and orofacial pain.
References
Rizzoli P, Mullally WJ. Headache. Am J Med. 2018; 131(1): 17-24. doi: 10.1016/j.amjmed.2017.09.005
Nouged E, Dajani J, Ku B, Al-Eryani K, Padilla M, Enciso R. Local anesthetic injections for the short-term treatment of head and neck myofascial pain syndrome: A systematic review with me-ta-analysis. J Oral Facial Pain Headache. 2019; 33(2): 183-198. doi: 10.11607/ofph.2277
Robbins MS, Kuruvilla D, Blumenfeld A, et al. Trigger point injections for headache disorders: Expert consensus methodol-ogy and narrative review. Headache. 2014; 54(9): 1441-1459. doi: 10.1111/head.12442
Mellick LB, McIlrath ST, Mellick GA. Treatment of headaches in the ED with lower cervical intramuscular bupivacaine injections: A 1-year retrospective review of 417 patients - CME. Headache. 2006; 46(9): 1441-1449. doi: 10.1111/j.1526-4610.2006.00586.x
Karadaş Ö, Gül HL, Inan LE. Lidocaine injection of pericra-nial myofascial trigger points in the treatment of frequent epi-sodic tension-type headache. J Headache Pain. 2013; 14(1): 44. doi: 10.1186/1129-2377-14-44
Venâncio Rde A, Alencar FG, Zamperini C. Different substanc-es and dry-needling injections in patients with myofascial pain and headaches. Cranio. 2008; 26(2): 96-103. doi: 10.1179/crn.2008.014
García-Leiva JM, Hidalgo J, Rico-Villademoros F, Moreno V, Ca-landre EP. Effectiveness of ropivacaine trigger points inactivation in the prophylactic management of patients with severe migraine. Pain Med. 2007; 8(1): 65-70. doi: 10.1111/j.1526-4637.2007.00251.x
Sabatke S, Scola RH, Paiva ES, Kowacs PA. Injection of trig-ger points in the temporal muscles of patients with myofas-cial syndrome. Arq Neuropsiquiatr. 2015; 73(10): 861-866. doi: Submit your article to this journal | https://openventio.org/submit-manuscript/ Systematic Review | Volume 9 | Number 1 | Butler D, et al 10.1590/0004-282X20150135
Mellick LB, Mellick GA. Treatment of acute orofacial pain with lower cervical intramuscular bupivacaine injections: A 1-year ret-rospective review of 114 patients. J Orofac Pain. 2008; 22(1): 57-64.
Hong CZ. Lidocaine injection versus dry needling to myofas-cial trigger point. The importance of the local twitch response. Am J Phys Med Rehabil. 1994; 73(4): 256-263. doi: 10.1097/00002060- 199407000-00006
de Craen AJ, Tijssen JG, de Gans J, Kleijnen J. Placebo effect in the acute treatment of migraine: Subcutaneous placebos are better than oral placebos. J Neurol. 2000; 247(3): 183-188. doi: 10.1007/ s004150050560
Beecham GB, Nessel TA, Goyal A. Lidocaine. In: StatPearls [Internet]. Treasure Island (FL), USA: StatPearls Publishing; 2022.
Hoskin KL, Kaube H, Goadsby PJ. Central activation of the trigeminovascular pathway in the cat is inhibited by dihydroergota-mine. A c-Fos and electrophysiological study. Brain. 1996; 119(Pt 1): 249-256. doi: 10.1093/brain/119.1.249
Kaube H, Katsarava Z, Przywara S, Drepper J, Ellrich, J, Diener HC. Acute migraine headache: Possible sensitization of neurons in the spinal trigeminal nucleus? Neurology. 2002; 58: 1234-1238. doi: 10.1212/wnl.58.8.1234
Abrahams VC, Anstee G, Richmond FJ, Rose PK. Neck muscle and trigeminal input to the upper cervical cord and lower medulla of the cat. Can J Physiol Pharmacol. 1979; 57: 642-651. doi: 10.1139/ y79-098
Piovesan EJ, Kowacs PA, Tatsui CE, Lange MC, Ribas LC, Werneck LC. Referred pain after painful stimulation of the greater occipital nerve in humans: Evidence of convergence of cervical afferences on trigeminal nuclei. Cephalalgia. 2001; 21: 107-109. doi: 10.1046/j.1468-2982.2001.00166.x
Bartsch T, Goadsby PJ. Stimulation of the greater occipital nerve induces increased central excitability of dural afferent input. Brain. 2002; 125: 1496-1509. doi: 10.1093/brain/awf166
Bartsch T, Goadsby PJ. Increased responses in trigeminocer-vical nociceptive neurons to cervical input after stimulation of the dura mater. Brain. 2003; 126: 1801-1813. doi: 10.1093/brain/ awg190
Bartsch T, Goadsby PJ. The trigeminocervical complex and migraine: Current concepts and synthesis. Curr Pain Headache Rep. 2003; 7: 371-376. doi: 10.1007/s11916-003-0036-y
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
All content published in Emergency Medicine (EM) is licensed under the Creative Commons Attribution 4.0 International License (CC BY 4.0). This license allows anyone to copy, distribute, transmit, and adapt the work — including for commercial purposes — provided appropriate credit is given to the original author(s) and source.
