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occipital neuralgia

the trigger point injections only offer releif for 3-5 days.does anyone know of a longer lasting injectable that works longer? i've heard that BOTOX might relieve the head/neck pain for months?! thanks bltsullivan
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Avatar universal
Hi Blt,
What is your name and how old are you?
Persistent occipital neuralgia can produce severe headaches that are difficult to control by conservative or surgical approaches.
I would like to quote a recent study which says the Botox injection offer better pain relief than any other analgesics.
Study name:
Botulinum toxin occipital nerve block for the treatment of severe occipital neuralgia: a case series.
Authors:
Kapural L, Stillman M, Kapural M, McIntyre P, Guirgius M, Mekhail N.
Pain Management Department, Division of Anesthesiology, Cleveland Clinic, Cleveland, Ohio 44195, USA. ***@****

They retrospectively describe a series of six patients with severe occipital neuralgia who received conservative and interventional therapies, including oral antidepressants, membrane stabilizers, opioids, and traditional occipital nerve blocks without significant relief.
Methods:
This group then underwent occipital nerve blocks using the botulinum toxin type A (BoNT-A) BOTOX Type A (Allergan, Inc., Irvine, CA, U.S.A.) 50 U for each block (100 U if bilateral). Significant decreases in pain Visual Analog Scale (VAS) scores and improvement in Pain Disability Index (PDI) were observed at four weeks follow-up in five out of six patients following BoNT-A occipital nerve block.
Observations:
The mean VAS score changed from 8 +/- 1.8 (median score of 8.5) to 2 +/- 2.7 (median score of 1), while PDI improved from 51.5 +/- 17.6 (median 56) to 19.5 +/- 21 (median 17.5) and the duration of the pain relief increased to an average of 16.3 +/- 3.2 weeks (median 16) from an average of 1.9 +/- 0.5 weeks (median 2) compared to diagnostic 0.5% bupivacaine block.
Following block resolution, the average pain scores and PDI returned to similar levels as before BoNT-A block.
Conclusion:
In conclusion, BoNT-A occipital nerve blocks provided a much longer duration of analgesia than diagnostic local anesthetics. The functional capacity improvement measured by PDI was profound enough in the majority of the patients to allow patients to resume their regular daily activities for a period of time.
I would like to know your decision and thoughts after going through this study.
Keep me informed.
Bye.
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Avatar universal
I have had BOTOX injections several times in the last 3 years with differing results.  One Dr. used eeg (I think) to detect over activity in the muscles and then targeted those areas for the Botox.  This was by far the most effective botox injections I received.  I had 60% reduction in pain for 3-4 months, the relief would then decrease to 0% by month 8.  The 1 time I had a different Dr perform the injections I got only 40% relief and it did not last nearly as long, maybe 5 months total.
I have not had any Botox for about 18 months because my current Dr at the U of U pain clinic believes that other muscles are overworked when some neck muscles are injected with the Botox.  I did develop chronic myofascial pain over a large area but I am not sure if the Botox and relaxation of some neck muscles contributed to this.
So in conclusion I got relief from the botox but beware of problems in other muscles developing if you try it yourself.  I would also advise finding a Dr who is very experienced with Botox especially for the specific problem of ON.  Lastly don't just let the Dr inject where he thinks you need it.  You need to identify all the muscles, and specific points in the muscle, where you have problems (nerve entrapment).  Mark them with a pen or have someone else mark the places you point out.  This is the only way you can be sure the Dr will inject your specific problem areas.  I used a theracane and significant pressure to find each spot where the nerves were sensitive.   You will likely be disappointed with the results if you don't have control/input over the injection sites.
Good luck,
Shane
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