Migraines & Stellate Ganglion Blocks
As anyone who suffers from migraines — or knows someone who suffers from migraines — can tell you, they are more than just a bad headache. Often debilitating to the point where you can’t get out of bed or need to sequester yourself in a darkened and quiet room, the recurrent neuromuscular disorder affects 1 in 6 American adults.
While numerous studies have been done, the exact cause of migraines is still unknown. The current treatment options include avoiding triggers, diet modifications, acupuncture, Botox injections, and medication, which can range from Excedrin Migraine to antipsychotics. Some treatments focus on stymying the severity of the symptoms once a migraine has started, and others try to lower the frequency they occur.
However, the treatments that are most effective at reducing the frequency of migraines come with potential side effects such nausea, vomiting, dizziness, dry mouth, and — in some rare cases — suicidal ideation.
A cycle many people who get migraines fall into is that the nausea from their migraine prevents them from eating so they end up taking over-the-counter medication on an empty stomach, which in turn causes them gastrointestinal distress, disrupting their diet and inevitably resulting in another migraine. This cycle can go on for days if not weeks, and takes a huge toll on the person’s overall well-being.
The good news is research is being conducted on a possible new treatment for migraines — the Stellate Ganglion Block (SGB) — and so far the results have been promising.
Stellate Ganglion Block: From Complex Regional Pain to PTSD to Migraines
A longtime treatment for complex regional pain syndrome, in the last decade SGBs have become a burgeoning treatment for PTSD symptoms. Through research being conducted on SGBs impact on PTSD symptoms, it was noted that in addition to relief from other symptoms of trauma, some patients reported having less frequent migraines. Spurred on by the anecdotal data, several studies have been performed specifically looking at the impact an SGB treatment has on a patient with migraines.
Case Report of Stellate Ganglion Block for Migraines
In 2020, a case report was published on the affect that a series of SGBs had on two patients, who both suffered from chronic, bilateral migraines without aura, accompanied by nausea and vomiting. “Patient 1 presented with headache of 8 on the visual analog scale (VAS), and 37 on the migraine disability assessement (MIDAS). Patient 2 reported headache of 7 on the VAS, and 32 on the MIDAS,” (Moon 2020).
Both patients received a series of bilateral SGBs over the course of a month and then bilateral SGBs monthly for three months. Then the patients reassessed their VAS and MIDAS scores, and both reported a decrease of at least at 50% reduction in their pain intensity and 80% reduction in their migraine disability (Moon 2020).
The researchers of the case report concluded that, “SGB can be an effective option to improve MIDAS scores and pain intensity in patients with refractory migraine,” (Moon 2020).
Observational Study of Stellate Ganglion Block for Migraines
An observation study was conducted in 2022, where 81 patients diagnosed with migraines received an SGB on the affected side once a week for four weeks. Their MIDAS scores decreased from an average of 14 pre-SGBs to an average of 7 post-SGBs, or 50%. The results of this study mirror the ones of the previous case report (Hou 2022).
This study also looked at the patients’ pre-SGB and post-SGB medication consumption for pain from migraines, and found that after the series of SGBs, there was a 69% decline. It has been shown that taking pain relievers more than 10 times a month can diminish their effectiveness. For people with migraines, that equates to rebound headaches after a migraine, prolonging the symptoms of their migraine (Hou 2022).
The researchers of the observational study stated that, “this study confirmed that ultrasound-guided SGB is an effective method to treat migraines. This technique can reduce pain and disability and then improve the quality of life of patients with migraines” (Hou 2022).
What is the Stellate Ganglion Block?
The stellate ganglion is a bundle of nerves located at the C6/C7 level of the neck and is apart of the sympathetic nervous system. When the sympathetic nervous system is overstimulated due to trauma or injury — such as chronic migraines — it can cause pain.
A Stellate Ganglion Block is an ultrasound-guided injection of local anesthesia around the stellate ganglion, numbing it for up to 6 hours, which allows for a reset of the sympathetic nervous system — comparable to restarting your computer when it gets glitchy.
Confirmation of a successful SGB block initially includes a droopy eye, redness of the eye, sinus congestion, difficulty swallowing, and a hoarseness while speaking. However, these symptoms resolve themselves within 6 hours of the SGB as the local anesthesia wears off, and are not permanent.
While relief from the frequency of migraines might not be immediate after an SGB, within a few weeks to two months, patients often report noticing a significant reduction in the amount of migraines they have had.
How long the migraine-relief will last is still being researched. Some patients require just one SGB for long term migraine reduction, while others schedule an SGB every few months as a preventative measure. Just as every patient is unique, so too is their response to treatment.
How can I learn more about SGBs for migraine relief?
Hou, J., Pu, S., Xu, X., Lu, Z., & Wu, J. (2022). Real-time ultrasound-guided stellate ganglion block for migraine: An observational study. BMC Anesthesiology, 22(1). https://doi.org/10.1186/s12871-022001622-8
Moon, S., Lee, J., & Jeon, Y. (2020). Bilateral stellate ganglion block for migraine. Medicine, 99 (18). https://doi.org/10.1097/md.0000000000020023