University of Calgary researcher and neurologist Dr. Serena Orr, MD, hadn't herself experienced a migraine attack until she moved to Calgary.
"I had mild headaches when I lived in different places, but nothing like what I've experienced since I moved to Calgary a few years ago," says Orr. "My first attack was during COVID. I couldn't get off the couch and I thought that I had COVID. I had severe nausea, headache, and brain fog. When the fog started to fade, I realized that I didn't have COVID; I had experienced my first severe migraine attack. I started to better understand my patients after this."
Pain from migraine is often debilitating. The pain can be so severe that people with migraine seek help in emergency departments (ED). Now, a new report finds occipital nerve blocks should be offered in EDs to treat acute migraine attacks.
"The evidence is strong that this is an effective and safe treatment to address pain from migraine attacks and should be offered to patients in emergency departments," says Orr, an associate professor at the Cumming School of Medicine and study co-lead.
Serena Orr's research has found that nerve blocks should be offered in emergency departments to treat acute migraine attacks. Photo Credit: Riley Brandt
The report, published in Headache: The Journal of Head and Face Pain, updates the 2016 American Headache Society guideline (which was also adopted in Canada) for the management of migraine attacks in the ED. The systematic review and meta-analysis used the same methodology as the 2016 study.
"This update marks a major change in emergency department migraine care, with stronger evidence supporting effective non-opioid treatments. Implementing these approaches can improve patient outcomes and reduce reliance on opioids," says study co-lead Dr. Jennifer Robblee, MD, a neurologist and migraine and headache disorders specialist at Barrow Neurological Institute, part of Dignity Health St. Joseph's Hospital and Medical Center in Phoenix, Ariz.
The authors note that opioid use remains common in headache-related ED care, despite decreasing from 54.1 per cent in 2007-10 to 28.3 per cent in 2015-18. The collaboration involved researchers at UCalgary's Hotchkiss Brain Institute, the Barrow Neurological Institute, New York and Ottawa.
Translating research into clinical practice
Researchers say the next steps will involve sharing and implementing the findings which may include training, as nerve block use requires trained personnel and supplies. Orr, who was lead author of the 2016 guidelines, is already connecting with colleagues to support training.
"The occipital nerves at the base of the skull bring in pain signals to the same area of the brain where pain signals from all over the head are coming in. By anesthetizing these nerves, patients get relief in two ways," says Orr. "First, the back of the head goes numb for several hours. Second, we see that pain signals more broadly from all over the head can be dampened down in the brain, given this shared area where pain signals come in for both occipital nerves and other nerves' branches from the head."
The review also included new medications since the 2016 guidelines were published.
Orr says the review allows the integration of the latest research into clinical care. She expects the new guidelines will be widely adopted in both the US and Canada.
Orr adds there is a lot more to be learned about how best to treat migraine in hospital. She is already working to understand if new and less-invasive treatments, like remote electrical neuromodulation, can be a safe and effective for use in the ED.
Serena Orr is an associate professor in the departments of Clinical Neurosciences, Community Health Sciences, and Paediatrics at the Cumming School of Medicine (CSM). She is a member of the Alberta Children's Hospital Research Institute, the Hotchkiss Brain Institute, the Mathison Centre for Mental Health Research & Education, and the O'Brien Institute for Public Health at the CSM. Orr also has an adjunct appointment in psychology at the Faculty of Arts.
