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Mellick Headache & Orofacial Pain Injection Discovery
 

CME Research Submission

Treatment of Headaches in the ED With Lower Cervical Intramuscular Bupivacaine Injections: A 1-Year Retrospective Review of 417 Patients

Larry B. Mellick, MD; Samuel T. McIlrath, MD; Gary A. Mellick, DO

Published October 2006

Objective.—The primary objective of this retrospective chart review is to describe 1 year’s experience of an academic emergency department (ED) in treating a wide spectrum of headache classifications with intramuscular injections of 0.5% bupivacaine bilateral to the spinous process of the lower cervical vertebrae.

Background.—Headache is a common reason that patients present to an ED. While there are a number of effective therapeutic interventions available for the management of headache pain, there clearly remains a need  or other treatment options. The intramuscular injection of 1.5 mL of 0.5% bupivacaine bilateral to the sixth or seventh cervical vertebrae has been used to treat headache pain in our facility since July 2002. The clinical setting for the study was an academic ED with an annual volume of over 75 000 patients.

Methods.—We performed a retrospective review of over 2805 ED patients with the discharge diagnosis of headache and over 771 patients who were coded as having had an anesthetic injection between June 30, 2003 and July 1, 2004. All adult patients who had undergone paraspinous intramuscular injection with bupivacaine for the treatmentof their headache were gleaned from these two larger databases and were included in this retrospective chart review. A systematic review of the medical records was accomplished for these patients.

Results.—Lower cervical paraspinous intramuscular injections with bupivacaine were performed in 417 patients. Complete headache relief occurred in 271 (65.1%) and partial headache relief in 85 patients (20.4%). No significant relief was reported in 57 patients (13.7%) and headache worsening was described in 4 patients (1%). Overall a therapeutic response was reported in 356 of 417 patients (85.4%). Headache relief was typically rapid with many patients reporting complete headache relief in 5 to 10 minutes. Associated signs and symptoms such as nausea, vomiting, photophobia, phonophobia, and allodynia were also commonly relieved.

Conclusion.—Our observations suggest that the intramuscular injection of small amounts of 0.5% bupivacaine bilateral to the sixth or seventh cervical spinous process appears to be an effective therapeutic intervention for the treatment of headache pain in the outpatient setting.

 

Critical care nurses David Levy (L) and Jean Isaac (C) confer in the intensive care unit of Tulane University Hospital in New Orleans February 14, 2006. For patients suffering  severe headaches who present to the emergency department, the painkiller bupivacaine injected into the muscles at the base of the neck provides safe and effective headache relief. REUTERS

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Anesthetic jab treats headache in the ER

Fri Nov 24, 2006 6:19 PM GMT
NEW YORK (Reuters Health) - For patients suffering severe headaches who present to the emergency department, the painkiller bupivacaine injected into the muscles at the base of the neck provides safe and effective headache relief.
These are the findings of a look back at all 417 headache patients, 18 years of age or older, who received this treatment over a 1-year period at a single emergency department.
Complete headache relief occurred in 65 percent and partial headache occurred in 20 percent of patients. Roughly 14 percent reported no significant headache relief and 1 percent reported a worsening of headache pain.
Overall, bupivacaine injections yielded a therapeutic response in 356 of 417 patients (85.4 percent), report Dr. Larry B. Mellick of the Medical College of Georgia in Augusta and colleagues in the journal Headache.
"Headache relief was typically rapid with many patients reporting complete headache relief in 5 to 10 minutes," the authors note. Headache relief was often accompanied by resolution of associated signs and symptoms such as nausea, vomiting, and sensitivity to sound and light.
Mellick and colleagues note that headache is a "common chief complaint" of patients who present to the emergency department. Many come to the ED as a last resort after other interventions have failed to provide headache relief.
Based on their experience, the authors say bupivacaine injection "appears to be a safe and effective therapeutic intervention for the treatment of headache pain caused by a spectrum of etiologies presenting to the ED setting."
SOURCE: Headache, October 2006

 

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This Paper was Discussed in the December 2006 Audio Tapes and CD's of Emergency Medicine Abstracts.

 

 A Retrospective Study of the Treatment of Acute Orofacial Pain Published in The Journal of Orofacial Pain.

Treatment of Orofacial Pain with Lower Cervical Bupivacaine Injections

Acad Emerg Med Volume 12, Number 5_suppl_1 157, © 2005 Society for Academic Emergency Medicine

ANESTHESIA

Treatment of Acute Orofacial Pain with Lower Cervical Intramuscular Bupivacaine Injections: A One-year Retrospective Review of 113 Patients

Larry B. Mellick, Gary A. Mellick and Armin Oskouei

Medical College of Georgia: Augusta, GA

ABSTRACT

Background: The injection of anesthetic (1.5 mL bupivacaine 0.5%) into the paravertebral musculature bilateral to the seventh cervical spinous process has previously been reported to relieve headaches as well as orofacial pain. Objective: We present preliminary data reflecting one year's experience using the lower cervical (C6–C7) bilateral paraspinous deep intramuscular injection with bupivacaine (0.5%) to treat acute orofacial pain of various etiologies in an academic emergency department (ED) setting. Methods: A retrospective review of over 700 ED patients coded as having had an anesthetic injection between June 30, 2003, and July 1, 2004, was accomplished. Additional patients were identified following a systematic review of patients with specific orofacial pain complaints presenting during the same period of time. All patients 18 years of age or older who had undergone paraspinous intramuscular injection with bupivacaine for the treatment of acute orofacial pain (odontalgia, mandible fractures, mandible dislocation, temporomandibular disorders, otitis media and externa, facial cellulitis, corneal abrasions, glaucoma, etc.) were included in this retrospective review. Results: Relief of orofacial pain was noted in 70 of 113 patients (61.9%). Another 38 patients (33.6%) reported partial relief from their orofacial pain and were given additional medications to attain complete relief. Five patients (4.4%) reported no significant pain relief following the injection. Orofacial pain relief was typically rapid with many patients reporting complete or partial pain relief in 5 to 15 minutes. A total of 108 of 113 patients (95.6%) reported pain reduction in response to the procedure. Conclusions: Our preliminary data suggest that the intramuscular injection of small amounts of bupivacaine into the paraspinous muscles bilateral to the C6 or C7 spinous process appears to relieve acute orofacial pain in the ED.

 
Cluster Headache Treated with Ritalin 

Headache: The Journal of Head and Face Pain
Volume 38 Page 710  - October 1998

Volume 38 Issue 9

Cluster Headache Management With Methylphenidate (Ritalin)

Gary A. Mellick, DO, Larry B. Mellick, MD

The authors report rapid cluster headache relief in a 43-year-old man with a 5-year history of refractory cluster headache. The patient described complete headache relief within 10 minutes of taking 10 mg of methylphenidate (Ritalin) when used to abort the onset of his headaches. Subsequently, a scheduled Ritalin dose taken each morning was sufficient to prevent his nightly headaches. In addition, 1 week of prophylactic methylphenidate therapy halted the series of cluster headaches. This is the first reported case of relief of cluster headaches with methylphenidate.

 

HEADACHE AND OROFACIAL PAIN SCIENTIFIC MEETING POSTERS


Ohio Osteopathic Convention June 23-26, 2005

Treatment of Headaches in the ED - Rapid Headache Relief Response Occurs in 30 Seconds to 5 minutes

Children Respond to the Injection as Well

Chronic Orofacial Pain Responds to the Lower Cervical Injection after Years

 

USAF Maj. R. diagnosed with otitis media had a painless ear exam following the C6-C7 intramuscular injection.

Airman L. J. had complete relief of her migraines with the lower cervical injection.

Sgt. R. T.  ("Rob") of USAF life support had his severe whiplash headache completely relieved one hour after an MVA and it never returned.

September 11, 2001, President George W. Bush at Barksdale AFB declaring war. The military continues to use the lower cervical injection for headache and face pain relief.