II. Indication
- Tension Headache triggered by spasm of the trapezius
- Eye Pain
- Orofacial Pain (Dental Pain)
- Trapezius Spasm
III. Mechanism
- Trigeminal Caudate Nucleus block
IV. Preparation
-
Lidocaine 1% or Bupivicaine 0.5%
- Draw up 3 cc in syringe
- Use 1.5 inch needle
V. Precautions
- Avoid directing needle inferiorly (risk of Pneumothorax at level of lung apex)
VI. Adverse effects
- Headache may pardoxically worsen with excessive infilltration
- Pneumothorax (see precautions above)
VII. Technique
- Insert needle at 1 to 1.5 inches lateral to midline to either side of C6-7 level
- Inserted into triangle of trapezius muscle on either side of the midline
- Aspirate prior to injection
- Inject 1.5 cc into each of the triangles of trapezius muscle at C6-7 level
- Repeat on opposite side of midline
VIII. Resources
- Mellick demonstration video of lower cervical injection
IX. References
- Mellick and Sacchetti in Majoewsky (2012) EM: Rap 12(8);7
- Mellick (2006) Headache 46(9): 1441-9 [PubMed]
