Yesterday I had what would be my 3rd occipital nerve block. It sounds big and scary, and it really isn’t, but kind of is. Thanks to that I’m supposed to have a couple months of lessened migraine pain. Some people get these and their migraines disappear. As usual, I am not one of those lucky people.
If you’re wondering exactly what happens, because maybe you have migraines, or a general curiosity about medical procedures here you go.
My wife came home and woke me up at noon. I was already in excruciating pain, and would have cancelled the appointment if it didn’t take 3 months for another one to be available with my neurologist. I ate the breakfast she made me and took all 20 of my pills (a mix of vitamins, supplements, and prescription meds). Next she found the clothes I asked for (sweat pants and a t shirt) and helped me dress. I ended up making us run late. I can only eat and dress so fast, and we had to be at the doctor at 1:30.
She dropped me off at the curb, and I hobbled up the steps, jealous of the three people with walkers I passed. I made it to the elevators where an infuriating comedy began of elevators arriving and people not letting me on, finally getting an elevator and the next person who arrived rerouted it, then ending up on the wrong floor again thanks to another person. By the time I reached the front desk I was a minute away from the 15 minute too late cut off (basically for any doc here if you’re more than 15 minutes late they cancel your appointment. Kind of like in college when you could leave if the professor didn’t show, only shitty).
My wife arrived a few minutes minutes later, when we both realized we had forgotten some important paperwork I needed the doctor to sign. After sitting while my wife dealt with giving our new insurance info, the copay, signing papers, I had the pleasure of children screaming around the lobby. Always pleasant during a migraine!
Finally we were lead back, my weight was taken (I gained 6 pounds, thanks steroids!) and blood pressure taken. I signed a form asking them to bill my insurance instead of paying the almost $400 charge up front. This part is kind of important. Most insurance does not cover nerve blocks for migraines. While it is a very common procedure, apparently “there is not enough research to prove it is medically effective or necessary”. So prepare to have this denied by your insurance, and you and your doc can attempt to battle it out with them.
Finally my neurologist showed up, a pretty awesome doc. He’s the 5th neurologist I’very seen since my migraines started 6 years ago, and the only one that listens to me and offers me treatment options beyond a handful of pills. While he prepped all the syringes he would need, I talked to him about other treatment options of this doesn’t work, or doesn’t work enough. An SPG block, DHE infusions, and the hated botox were all mentioned. Plans were made. I requested a small table to rest my head on for the first part of the injections, and one was brought in.
Beware, things get a big gross and graphic from here.
First, I tilted my head forward, leaning it on my arms on the table. He felt around my scalp for the places he wanted to inject. The first time this was done was in the back center of my skull. This time it would be just a few inches off the center on each side, starting with my left. The needle is inserted, which hurts, a lot. But the solution of lidocaine and steroid hurts more. I breathed through the pain, slowly counting each breath in and out. Now, I’m not sure if the needle is then reinserted into a different direction of the nerve in the same spot, or just rotated while it’s still in there. It feels like it’s rotated, pushed in further, and possibly bent, then more solution is injected.
When the right side was done, trigger points were started. For me, thesp injections are the same solution, injected into areas on my neck and shoulders that cause my migraines to be worse. Some people get them in other spots on their scalp. For my trigger points I had 2 at the base of my skull, three on each side of my neck, and 2 on each side of my shoulders, an area that loves to tense up and make my migraines so much worse.
Now, this is all painful. On a pain scale I would give just that part I described about a 6, maybe 7. The next part, that gets an 8.5, sometimes a 9. I tear up during it, if that says anything.
Next, there are trigger points in my eyebrows and temples. The brows are by far the worst. I had to sit back in the chair while it is adjusted so the doctor can see properly (almost like a dentists chair). Two injections are done in each brow. The needle has to pass through your skin, which feels like it takes forever and the solution feels like a hive of wasps is assaulting your brow. Then it’s repeated on the next brow. I spent the rest of the day with huge dried blobs of blood in my white blonde brows. Not a good look. The two injections to the temples are next, and while painful, are almost a relief compared to the brows.
Once all the blood is wiped off your face, scalp, neck, and shoulders, you’re all done! My head felt numb for the rest of the day. About an hour before bed my had and neck began to ache, which I applied an ice pack to while watching Teen Wolf.
Today, all of the injection sites are swollen and tender. Because of this I have a fairly bad migraine, and woke up much earlier than usual, unable to find a comfortable resting position for my head. I’very taken my migraine meds, NSAID’s, and pain meds. I’m still in bed, fatigued and trying not to move. If this is anything like the last 2 times, in less than a week my migraines will be at a constant lower pain, and I might go 2 whole months without a migraine that sends me to the ER. Worth it.