Ultrasound guidance helps significantly improve the effectiveness of this block for acute and chronic headache and cervicogenic pain.
so this patient has cervical disc disease as well as for cerathropathy manifesting his cervical genic headache and occipital neuralgia what we're going to do is an occipital nerve block of the greater branch and possibly some medial branch nerve blocks under ultrasound guidance okay first i'm going to do the occipital nerve block looking for this the bifid spinous process which is c2 i'm going to scan laterally splenous capitalist is a superior muscle oblique capitalist inferior is underneath and the nerve it's located between them a little pinch okay okay it's the first part the other side's fine right yeah okay so now we're going to look at the medial branch nerves this is an axial cut of the cervical spine in which i'm looking at the articular processes of the facet joints post to posterior you have the spinous process which is just a horizontal flat hyperechoic line with hypotenuse tissue behind it and moving anterior you see the exiting nerve root and the foramen looking for the medial branch nerve which may appear as a hyperdense small structure on the articular process karen is this where your pain is coming from or lower down oh the next pain the head pain is there it's right there okay okay little pinch feel that yeah the medication is spreading over the medial branch nerve on top of the articular process i'm going to go to another level mainly up here should i go a little higher it goes that way up into my head okay fair enough take an oblique approach you can see the cervical medial branch nerves sometimes under oblique view here it is can you decrease the depth again okay so the meow branch nervous here on top of the hyper alcoholic bone with an oblique approach and i'm going to go center it and with an out-of-plane approach i'm going to approach the nerve little pinch karen okay aspirate inject next to the nerve feel that in the spot of your pain okay you could look up is all your pain covered or did i miss a spot on the left side so here i did a occipital nerve block and i did medial branch nerves to alleviate the occipital neuralgia aspect of her pain as well as some of the cervical cervical facetogenic aspects of her pain because i used an ultrasound and not fluoroscope i didn't count the levels the same way in this case i actually counted downwards from the c2 transverse process and it was an estimate i probably anesthetized the c3 and the c4 medial branch nerve and the patient is feeling better so hopefully this will give her long-term relief thank you you
