The publication of this book comes at a time when the use of interventional procedures for the management of headaches and facial pain are gaining recognition as part of multidisciplinary management of these patients. This is because approximately one in five patients treated with pharmacologic medical management for their headaches do not experience improvement of their symptoms, and recent studies have documented the efficacy of these procedures as an alternative for patients with medically resistant headaches and facial pain. Some of the techniques detailed in this book are easy to implement in a busy outpatient center (e.g., occipital, supraorbital, supratrochlear, and infraorbital nerve blocks). Other techniques require a steep learning curve. This is the reason why special interest groups have become very popular, not only in the American Headache Society but also in other societies such as the American Society of Regional Anesthesia and Pain Medicine. Dr. Narouze, the editor of this book, was involved in the creation of both of these special interest groups. These groups are now responsible for organizing workshops, discussion forums, and review articles that are helping not only pain specialists but also others learning the value of these techniques. Interventional Management of Head and Face Pain includes 20 chapters, which in turn are organized into five sections that cover the whole spectrum of these techniques: superficial and deep head and neck blocks, radiofrequency lesioning of pain generators in these areas, and neuromodulation techniques.
The first section gives the reader a good background on the classification of headaches and then defines intractable and pharmacologically resistant headaches and face pain. This section helps the reader appropriately identify the patients who are candidates for these procedures by providing a chapter on suggested algorithms for diagnosis and management.
The second section deals with nerve and ganglion blocks for head and face pain. The seven chapters in this section have a wealth of illustrations, ultrasound, and fluoroscopy images that help the practitioner, not familiar with these procedures, gain baseline knowledge on these procedures. The ultrasound images should encourage and motivate pain physicians not currently involved with ultrasound-guided techniques to seek education in this new imaging alternative.
The third section covers the significantly debated topic of cervicogenic headache. The first of the four chapters is on the diagnostic criteria for the common sources of this problem and closes with an algorithm for its diagnosis and treatment. The rest of the chapters in this section discuss indications for steroid injections and radiofrequency ablation of the structures thought to be involved in the development of cervicogenic headache. These chapters also have several illustrations, ultrasound, and fluoroscopy images on how to perform these procedures.
The fourth section deals with the pharmacologic alternatives for IV therapies, the use of onabotulinum toxin A injections, and the role of epidural blood patches in intractable headaches. The chapter on IV therapies has a wealth of information on the alternative therapies and the different protocols for administration.
The last section covers occipital nerve stimulation and sphenopalatine ganglion stimulation with the use of traditional equipment and with the soon to be available technology, which uses a small inductively coupled sphenopalatine ganglion stimulator implants that can be activated by an external energy delivery control device. This device is implanted via a transoral infrazygomatic approach via a small incision in the gingival mucosa above the maxillary molars and then fixed with screws to the zygomatic process of the maxillary bone. The section’s last chapter is a review on the use of deep brain and motor cortex stimulation for head and face pain that provides a clear and concise description of the procedures, indications, and expected success.
The book is well written. The collaborators are all experts in the field. Considering that in general, pain physicians have not been involved in the management of these patients, one would hope that this book will prop up knowledge in the area and help those practitioners looking at getting involved in the treatment of these patients to attain the baseline knowledge to acquire the skills to overcome the steep learning curve associated with the performance of these blocks. Moreover, the abundance of ultrasound images should encourage those practitioners who are not familiar with this imaging technique to enroll in ultrasound courses to develop the skills necessary to perform some of these blocks.