Nasal 'Nerve Block' May Help Ease Kids' Migraines
SUNDAY, March 5, 2017 -- Kids and teens who suffer with migraines may find relief from a nasal "nerve block" that's commonly used in adults with the debilitating headaches, a new study suggests.
During the procedure, a catheter is placed in each nostril and inserted until it reaches a bundle of nerves at the back of the nose. At that point, an anesthetic is released that deadens those nerves, thus relieving the headache pain.
"The treatment does not require needles and often gives relief in just minutes, and relief can last for up to months," said lead researcher Dr. Robin Kaye, from Phoenix Children's Hospital.
"Migraine headaches are really common in the pediatric population, and affect up to 12 percent of kids over the age of 12," she noted.
These headaches can be debilitating for kids, and especially for teenagers, Kaye said. "When kids have these, it prevents them from participating in school, sports, music and time spent with friends and family," she said.
However, one headache expert had reservations about the study, noting that the therapy carried some risks while not providing significantly greater pain relief than existing medications.
In adults, the procedure is often done in a doctor's office. A catheter or swab is inserted blindly until it reaches the nerve bundle. At that point, the anesthetic, usually lidocaine, is released.
In the study, Kaye's team used a fluoroscope to ensure that the catheter was in the right place before the anesthetic was applied. A fluoroscope is a medical imaging tool that shows a continuous X-ray image on a monitor, almost like an X-ray movie.
Kaye pointed out that the procedure is not a first-line therapy for migraine. Only children who have severe migraine and have failed other treatments are eligible.
The lowest levels of radiation possible were used during the procedure, she added, and no side effects were seen.
"It is not a cure for migraines. But it really can help improve the lives of these patients that are severely affected by migraine headache, and it can allow them to get back to their daily life sooner," Kaye said.
The findings were scheduled to be presented Sunday at the Society of Interventional Radiology meeting, in Washington, D.C. Research presented at meetings is considered preliminary until published in a peer-reviewed journal.
For the study, Kaye and colleagues used the procedure more than 300 times on 200 patients aged 7 to 18 at Phoenix Children's Hospital. The level of patients' pain was assessed on a scale of 1 to 10 before the procedure. Some patients were sedated, while others weren't.
Ten minutes after treatment, patients were asked about their level of pain. A statistically significant decrease in headache scores was seen, with an average pain reduction of more than 2 points on a 10-point scale, Kaye said.
But one headache specialist was skeptical.
"I don't think the evidence from this study is robust enough to recommend that people start using this," said Dr. Suzanne Hagler. She is director of the headache center at Nicklaus Children's Hospital in Miami.
Hagler is also concerned about the danger of exposing kids to radiation. "If it could be done without radiology, it would be more useful," she said.
Sedating kids is also worrisome because sedation carries its own dangers, she noted.
Moreover, the amount of pain relief seen with this procedure isn't enough to use it instead of IV medications, Hagler suggested.
"The goal is to bring the patient's pain level down to zero. And that's our goal when we use IV medications," she said. The procedure is also very uncomfortable and can cause a bloody nose, she added.
"If a child's headaches are becoming frequent and interfering with school and social activities, parents should have their child evaluated, because we have many treatments that we can use to decrease the frequency and severity of the headaches," Hagler said.
Visit the American Migraine Foundation for more on kids and migraines.
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Posted: March 2017