Headache is a common chief complaint of patients presenting to the emergency department (ED),
accounting for approximately 3 million ED visits per year. Headache treatment is often a
source of frustration for both patients and providers. By the time patients with benign
headaches arrive in the emergency department, they have often failed non-invasive therapeutic
attempts and providers are often left with few therapeutic options. Treatment of benign
headache varies between providers, often including systemic medications with a multitude of
possible side effects. In recent years, there has been preliminary investigation into
anesthetic injections for the undifferentiated headache patient presenting to the emergency
department. It has been proposed that these patients presenting with benign headache might
benefit from this novel treatment.
Patients that present to the Emergency Department with a diagnosis of benign or primary
headache with serious or life-threatening causes of headache will be offered enrollment into
the study.
Following consent, subjects will receive either 0.5% bupivacaine injected bilaterally in the
paraspinal musculature of the cervical spine or the standard treatment with intravenous
Prochlorperazine. The subjects will complete a validated pain scale before, and 20 minutes
after injection. At twenty minutes post-injection, the subject will be reevaluated for
symptoms. The subject will then be eligible for discharge or standard treatment at the
discretion of the treating physician.
Subjects will be followed for 72 hours after enrollment for headache recurrence. Subjects
will be monitored for immediate and post-discharge complications.