The use of BOTOX as a therapeutic neurotoxin has been well established over the past 20 years. Botox is FDA approved for treatment of multiple indications including Cervical Dystonia and Chronic Migraine . Botox has demonstrated its efficacy for symptomatic treatment of both conditions and requires re-injections about every 12 weeks. This injection technique has become standard of care by most neurologists over the past 5 years, but at iNHS, Dr. Chehrenama has in-depth experience arising from almost 20 years of clinical trials in the field of neurotoxins for therapeutic indications. This in-depth experience allows for a more individualized treatment approach with attention to the overall scientific data. At this time, given the limitations of a purely video based consultation , the following injections and procedures are no longer offered. However, Dr. Chehrenama can be consulted for new options if these injections offered relief in the past, but no longer serve their therapeutic benefit now.
Occipital Nerve Blocks
The use of anesthetic agents with or without added steroids injected via a very small 30 gauge needle directly into the area of occipital nerves can provide immediate relief for a persistent headache.
This technique is modified depending on the purpose it serves. For example, in post-traumatic headaches, the use of repetitive occipital nerve blocks over a course of a few weeks can reduce secondary occipital neuralgia while the underlying whiplash related musculoskeletal strain is addressed. Another option maybe to use Occipital Nerve Blocks in a diagnostic sense to assess the location of pain generation within the head and scalp. Generally the use of added steroids are reserved for cluster headaches and/or those who do not respond to anesthetic agents alone.
Other Head/Face Nerve blocks
Other sensory peripheral nerves that cover the head and face include the supraorbital, supra-trochlear, zygomatico-temporal as well as infra-orbital nerves. Knowledge of the neuro-anatomy is of utmost importance in providing a safe and reliable nerve block experience. Any nerve block may have unpredictable response and/or incomplete anesthesia depending on anatomic variations of each individual patient. At iNHS, Dr. Chehrenama can augment her Headache Subspecialist skills of injections with her training in Neuromuscular disorders, combined with osteopathic manual palpatory skills for a more optimal injection experience that is individualized to the anatomy. This generally leads to a more favorable outcome.
Sphenopalatine Ganglion Blocks
The nose is an old target for Headache and Facial pain treatment, but has now become a more comfortable experience with the use of novel flexible catheters. The response may be immediate or delayed and duration of pain relief has been reported as variable. Side effects are generally minimal including discomfort during and after the procedure, a numb sensation when swallowing, bitter taste from the anesthesia, bleeding from the nose and light-headedness. These side effects typically resolve within minutes to a few hours. There is a very small risk of infection and/or allergic reaction from the anesthetic agents.
SPG blocks have been reported to treat the following conditions:
- Cluster headache
- Trigeminal Neuralgia
- Paroxysmal hemicrania
- Herpes Zoster
- Atypical Facial Pain
- Temporomandibular Disorder Pain
- Nasal Contact Point Headache
- Vasomotor Rhinitis
- Complex Regional Pain Syndrome