EVERY INJECTION
Placed under ultrasound or fluoroscopic guidance
Not an upgrade and not on request — the default. Guidance is why a block reaches its target, why it is safe around the vessels of the head and neck, and why a block that doesn’t relieve your pain is trustworthy diagnostic information rather than a possible miss.
What we can do in a single visit to stop an attack that is happening now, and the targeted procedures for headache that keeps coming back. Which one fits depends on the headache, not on preference.
Stopping the attack you have now
IV migraine therapy
For a migraine attack that has not responded to oral medication, or where vomiting makes swallowing anything pointless. Hydration plus an anti-nausea agent, magnesium and an anti-inflammatory, given intravenously so absorption is not a variable.
Oxygen therapy
High-flow oxygen through a non-rebreather mask is a first-line abortive for cluster headache and one of the few treatments in headache medicine that is both highly effective and essentially free of side effects. We also offer hyperbaric oxygen; the evidence base for that is narrower and we say so on the page.
Sphenopalatine ganglion block
The sphenopalatine ganglion sits just behind the nasal cavity and carries much of the autonomic signalling that produces the watering eye and blocked nose of a cluster attack. Anesthetic is applied through the nostril. No needle, no sedation.
Targeted nerve and joint procedures
Occipital nerve block
Local anesthetic where the greater and lesser occipital nerves emerge at the base of the skull. The strongest fit is occipital neuralgia and cervicogenic headache; it is also used as an add-on in cluster bouts. Ultrasound guided, because the occipital artery runs with the nerve.
Atlanto-axial (C1–C2) injection
The joint at the very top of the neck is a recognised and frequently missed source of cervicogenic headache, because it sits above the levels most cervical imaging and most injections address. Performed under fluoroscopy with contrast confirmation — never blind.
Trigeminal nerve block
The trigeminal nerve is the sensory supply to the face and the pathway through which migraine and cluster headache generate pain. Which branch is blocked depends on where the pain actually is.
Stellate ganglion block
A block of the cervical sympathetic chain, for cluster headache, sympathetically maintained facial pain and upper-limb complex regional pain syndrome. Ultrasound guided — the target sits among the carotid, the jugular and the vertebral artery.
When a headache is an emergency
Go to an emergency department or call 911 instead of coming here if you have a headache that reached maximum intensity within seconds, a headache with fever or a stiff neck, any weakness, numbness, trouble speaking, vision loss or confusion, or a headache following a head injury.