II. Indication

  1. Tension Headache triggered by spasm of the trapezius
  2. Eye Pain
  3. Orofacial Pain (Dental Pain)
  4. Trapezius Spasm

III. Mechanism

  1. Trigeminal Caudate Nucleus block

IV. Preparation

  1. Lidocaine 1% or Bupivicaine 0.5%
    1. Draw up 3 cc in syringe
    2. Use 1.5 inch needle

V. Precautions

  1. Avoid directing needle inferiorly (risk of Pneumothorax at level of lung apex)

VI. Adverse effects

  1. Headache may pardoxically worsen with excessive infilltration
  2. Pneumothorax (see precautions above)

VII. Technique

  1. Insert needle at 1 to 1.5 inches lateral to midline to either side of C6-7 level
    1. Inserted into triangle of trapezius muscle on either side of the midline
  2. Aspirate prior to injection
  3. Inject 1.5 cc into each of the triangles of trapezius muscle at C6-7 level
  4. Repeat on opposite side of midline

VIII. Resources

  1. Mellick demonstration video of lower cervical injection
    1. http://www.youtube.com/watch?v=0to5wzftpnM

IX. References

  1. Mellick and Sacchetti in Majoewsky (2012) EM: Rap 12(8);7
  2. Mellick (2006) Headache 46(9): 1441-9 [PubMed]

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