.    Cervical injection for headache
Larry Mellick MD interviewed by Al Sacchetti MD

1. .    Technique? Take a 3mL syringe with lidocaine or 0.5% bupivacaine and inject about half of it in the triangle of muscle around C6 and C7 (about 1 to 1.5 inches from the midline). Aspirate and then inject slowly. Perform bilaterally. Don’t aim down towards the dome of the lung to avoid pneumothorax; otherwise there aren’t any structures in this area aside from the muscle.
2. .    Online videos demonstrating the technique can be seen at: http://www.youtube.com/watch?v=oy1lggvxV9Y http://www.youtube.com/watch?v=0to5wzftpnM
3. .    Why this works is unclear but suspect involvement of the trigeminal caudate nucleus which acts as a relay center. Patients have allodynia due to central sensitization.
4. .    Is there are role for repeat injections? Probably but beware because you can induce headaches with injection of too much into that area.
5. .    Mellick et al. Treatment of headaches in the ED with lower cervical intramuscular bupivacaine injections: a 1-year retrospective review of 417 patients. Headache. 2006 Oct;46(9):1441-9. 
C2 
C3 C4 C5 C6 
C7 
Injection 
sites
EM:RAP Written Summary August 2012 Volume 12 Issue 8

1. .    http://www.youtube.com/watch?v=oy1lggvxV9Y
2. http://www.youtube.com/watch?v=0to5wzftpnM

http://www.youtube.com/watch?v=oy1lggvxV9Y http://www.youtube.com/watch?v=0to5wzftpnM