Nerve Block Management and Relief from the Hemicrania Continua

Explore effective hemicrania continua with nerve block management for long-term relief and improved quality of life from headaches.

Abstract

As a clinician dedicated to integrative and functional medicine, I continually explore the most effective, evidence-based strategies for managing complex pain syndromes. This educational post details the clinical management of a 71-year-old patient presenting with a right-sided headache characteristic of Hemicrania Continua. We will trace the diagnostic process, from physical examination and nerve palpation to targeted nerve blocks. I will explain the anatomical and physiological basis for this condition and detail the specific nerves involved: the supratrochlear, supraorbital, zygomaticotemporal, and auriculotemporal nerves. The post will thoroughly describe the procedure, including the anesthetic mixture used (lidocaine and bupivacaine), the injection technique, and the immediate post-procedure assessment. I will also explain how this intervention fits within our comprehensive, multidisciplinary framework at Injury Medical Clinic. This framework integrates advanced chiropractic care, functional medicine, and essential medical oversight from our Medical Director, Dr. Maria Guadalupe Cardenas, MD, to provide a holistic, patient-centered treatment approach. We aim not only to alleviate acute symptoms but also to break the cycle of chronic pain and restore long-term function and well-being.

Introduction: The Challenge of Chronic Unilateral Headaches

In my years of clinical practice, I have encountered countless individuals whose lives are profoundly impacted by chronic pain. Among the most challenging and debilitating of these conditions are persistent, one-sided headaches. On September 1, 2026, I had the opportunity to work with a 71-year-old woman who presented to our clinic with a severe, right-sided headache. Her symptoms were consistent with a diagnosis of Hemicrania Continua, a rare but relentless primary headache disorder characterized by continuous, unilateral pain that fluctuates in intensity.

Upon her arrival, she rated her pain as a seven out of ten on a standard pain scale—a significant level of discomfort that disrupts daily life. My immediate goal was to provide rapid and effective relief while also considering a long-term strategy to manage her condition. This case offers an excellent opportunity to discuss our integrative approach, which combines precise diagnostic techniques with targeted therapeutic interventions in a collaborative, multidisciplinary setting.

At Injury Medical Clinic, our philosophy is rooted in a deep understanding of how the body’s systems are interconnected. We do not simply treat symptoms; we seek to understand and address the underlying causes of dysfunction. This patient’s case highlights the power of combining modern, evidence-based medical procedures with the foundational principles of chiropractic and functional medicine.

Our Collaborative Care Model: The Synergy of Medicine and Chiropractic

A cornerstone of our practice at Injury Medical Clinic PA is the powerful synergy between different medical disciplines. I am Dr. Alex Jimenez, and my extensive training as a Doctor of Chiropractic (DC), Advanced Practice Registered Nurse (APRN), and Board-Certified Family Nurse Practitioner (FNP-BC), along with certifications in functional medicine (CFMP, IFMCP), allows me to view patient care through multiple lenses. However, our comprehensive care is truly strengthened through my collaboration with Dr. Maria Guadalupe Cardenas, MD.

Dr. Cardenas is a highly respected physician, board-certified in Internal Medicine, with over 40 years of invaluable experience. As our Medical Director and Collaborative Physician, she provides essential medical oversight and brings deep knowledge critical to our multidisciplinary framework. Her NPI is #1164426749, and she is licensed to practice in Texas under license #J2933. This partnership between a chiropractor/nurse practitioner and an internist is fundamental to our integrative model, especially for complex cases involving both musculoskeletal and systemic issues, such as personal injury, chronic pain, and metabolic dysfunction.

Our integrated team approach ensures that patients receive:

• Comprehensive Diagnostics: We combine the physical and biomechanical assessments of chiropractic care with the systemic and pharmacological expertise of internal medicine.
• Safe and Effective Treatment Planning: Cardenas provides medical direction for procedures like the nerve blocks discussed here, ensuring they are appropriate, safe, and medically sound for each patient.
• Holistic Management: While I may focus on neuromuscular and structural alignment through chiropractic adjustments and functional medicine protocols, Dr. Cardenas manages underlying medical conditions, reviews diagnostic imaging and lab work from a medical perspective, and guides conventional medical treatments when necessary.
• Coordinated Care: Our patients benefit from seamless communication between providers. We work together on rehabilitation plans, personal injury case management, and long-term wellness strategies, ensuring we address all aspects of a patient’s health in a unified way.

This structure allows us to offer a spectrum of services—from spinal adjustments and rehabilitation to advanced medical interventions—all under one roof, creating a patient journey that is efficient, thorough, and highly effective.

Part 1: The Diagnostic Journey—Identifying the Source of Pain

A Detailed Physical Examination: The Art of Palpation

When the 71-year-old patient presented with her right-sided headache, my first step was to conduct a thorough physical and neurological examination. Hemicrania Continua is a clinical diagnosis, meaning it is based on the patient’s history and physical exam rather than a single lab test or imaging study. However, my goal was to move beyond the general diagnosis and pinpoint the precise anatomical structures contributing to her pain. This is where the art of palpation, guided by a deep knowledge of neuroanatomy, becomes paramount.

The patient described her pain as continuous, with moments of severe, stabbing exacerbations, a classic feature of this condition. I focused my examination on the distribution of the trigeminal nerve (Cranial Nerve V), the face’s primary sensory nerve and a key feature in headache syndromes such as trigeminal neuralgia, cluster headaches, and Hemicrania Continua. The trigeminal nerve has three main branches: the ophthalmic (V1), maxillary (V2), and mandibular (V3) divisions. My examination targeted the terminal sensory branches of these divisions, which are often superficial and can become points of irritation or entrapment.

Using gentle but firm pressure, I palpated specific points on her forehead, temple, and cheekbone. My clinical experience has taught me that these superficial nerves often emerge from small openings in the skull called foramina. These exit points can become sites of nerve compression or irritation due to fascial tension, muscle tightness, or inflammation, turning them into “trigger points” for headache pain.

I carefully marked the points of maximum tenderness with the retracted tip of a ballpoint pen. This method allows for precise localization without causing additional discomfort from excessive pressure. The examination revealed four distinct and highly sensitive locations on the right side of her head.

The Four Key Nerves Implicated in Her Headache

The patient’s pain response was immediate and specific when I palpated the following four locations, confirming the involvement of specific peripheral nerves:

• The Supratrochlear Nerve:

• • Anatomy: This nerve is one of the terminal branches of the frontal nerve, which itself is a branch of the ophthalmic division (V1) of the trigeminal nerve. It exits the orbit on the medial (inner) side of the eyebrow. It runs superiorly to provide sensation to the skin of the lower central forehead, the bridge of the nose, and the medial part of the upper eyelid.
  • Clinical Relevance: When I applied pressure just above the inner corner of her right eyebrow, she reported a sharp, familiar pain. “Yes,” she confirmed, indicating this was a source of her discomfort. This nerve’s superficial course makes it vulnerable to compression from the overlying corrugator supercilii and procerus muscles, which are involved in frowning and can become chronically tense.

• The Supraorbital Nerve:

• • Anatomy: This is the larger terminal branch of the frontal nerve (also from the V1 division). It exits the skull through the supraorbital foramen or notch, a small groove you can often feel along the upper rim of the eye socket (orbital rim), typically in line with the pupil. After exiting, it divides into medial and lateral branches that provide sensation to most of the forehead, the scalp as far back as the vertex (top of the head), and the upper eyelid.
  • Clinical Relevance: Palpating a point directly above her pupil along the orbital rim elicited another strong pain response. “Yes, right there,” she affirmed. The supraorbital nerve is a very common culprit in frontal headaches. Entrapment at the supraorbital notch is a well-documented phenomenon and can be a primary driver of pain in conditions like chronic migraine and Hemicrania Continua. (Janis et al., 2010).

• The Zygomaticotemporal Nerve:

• • Anatomy: This nerve branches from the zygomatic nerve, which originates from the maxillary division (V2) of the trigeminal nerve. It travels along the lateral wall of the orbit, then passes through a small foramen in the zygomatic bone (cheekbone) to supply a small patch of skin on the side of the forehead in the temporal region.
  • Clinical Relevance: The third point of tenderness was located on the lateral aspect of her orbital rim, over the temporal area. When I pressed there, she again confirmed the pain. The powerful temporalis muscle, one of the main muscles of mastication (chewing), can compress this nerve. Chronic clenching, bruxism (teeth grinding), or general temporomandibular joint (TMJ) dysfunction can lead to hyperactivity and tension in this muscle, irritating the zygomaticotemporal nerve.

• The Auriculotemporal Nerve:

• • Anatomy: This nerve arises from the mandibular division (V3) of the trigeminal nerve. It has a complex path, wrapping around the neck of the mandible and ascending just in front of the ear, alongside the superficial temporal artery. It provides sensation to the side of the head, the temporal region, the tragus of the ear, and portions of the outer ear canal and eardrum. It also carries parasympathetic fibers to the parotid gland.
  • Clinical Relevance: The final pain point was identified just anterior to her ear, in the preauricular area. This location corresponds directly to the auriculotemporal nerve’s path. Its proximity to the superficial temporal artery and the temporomandibular joint (TMJ) makes it highly susceptible to irritation. Inflammation of the artery (as in temporal arteritis) or mechanical stress from TMJ dysfunction can both trigger pain along this nerve’s distribution, often perceived as a headache in the temple.

By systematically identifying these four points of exquisite tenderness, we had effectively created a “pain map” that corresponded perfectly to the anatomical pathways of these specific sensory nerves. This detailed diagnostic work forms the foundation for a targeted, effective treatment plan. It transforms the treatment from a generalized approach to a precise, neuroanatomically guided intervention.

Part 2: The Therapeutic Intervention—Performing Targeted Nerve Blocks

The Rationale for Peripheral Nerve Blocks

Once we confirmed the involvement of these four peripheral nerves, the logical next step was to temporarily block their signals to see if we could interrupt the pain cycle. This is the principle behind a peripheral nerve block. By injecting a local anesthetic agent directly at the site of nerve irritation, we can achieve several goals simultaneously:

1. Diagnostic Confirmation: If the pain is significantly reduced or eliminated immediately after the injection, it provides powerful diagnostic evidence that the targeted nerve is indeed a primary contributor to the patient’s headache. This is often referred to as a “diagnostic block.”
2. Therapeutic Relief: The anesthetic provides immediate, albeit temporary, pain relief. This can be profoundly beneficial for a patient suffering from severe, unrelenting pain.
3. Breaking the Pain Cycle: This is perhaps the most crucial long-term goal. Chronic pain is not just a symptom; it is a self-perpetuating neurological process. Continuous pain signals can lead to a phenomenon known as central sensitization, where the central nervous system (the spinal cord and brain) becomes hyperexcitable and amplifies pain signals. This makes the person more sensitive to pain and can cause pain to persist even after the initial trigger is gone. By blocking the peripheral pain signals for a period of time, we can “calm down” the central nervous system, disrupt this feedback loop, and potentially reset the pain threshold. This can lead to pain relief that lasts much longer than the anesthetic’s chemical duration. (Woolf, 2011).

Preparing for the Procedure: Precision and Safety

With a clear therapeutic goal, we prepared for the nerve blocks. Safety and precision are paramount in any injection-based procedure, especially when working on the face and near the eyes.

• Marking the Sites: As mentioned, I had already marked the four target locations lightly with ink. Precision is key. We are not just injecting into a general area of tenderness; we are aiming for the specific anatomical location where the nerve is most superficial and accessible.
• Aseptic Technique: Next, I prepared the skin to minimize infection risk. I used Betadine (povidone-iodine), a broad-spectrum antiseptic, to thoroughly cleanse the four marked areas. I applied it gently, ensuring the entire target zone was covered.
• The Anesthetic Cocktail: For this procedure, I chose a specific combination of two local anesthetics. The mixture consisted of:

• 50% Lidocaine 1% with Epinephrine: Lidocaine is a fast-acting anesthetic. Its effects are typically felt within minutes, which is ideal for providing rapid pain relief and for confirming the diagnostic accuracy of the block. Adding epinephrine, a vasoconstrictor, serves two important purposes. First, it constricts local blood vessels, reducing bleeding at the injection site. Second, and more importantly, it slows the rate at which the anesthetic is absorbed into the bloodstream. This keeps the anesthetic concentrated at the target site for longer, thereby prolonging its effect.
• 50% Bupivacaine 0.5%: Bupivacaine is a long-acting anesthetic. While it takes longer to take effect than lidocaine (typically 10-20 minutes), its duration of action is significantly longer, often lasting for several hours.
• The Synergy: Combining these two agents gives the best of both worlds: lidocaine’s rapid onset for immediate relief and diagnostic feedback, and bupivacaine’s extended duration for a longer therapeutic window and a better chance of breaking the pain cycle. I prepared a syringe with this mixture, planning to inject a total of one milliliter (1 mL) at each of the four sites.

• Needle Selection: Needle choice is also critical for patient comfort and procedural accuracy. I used a 30-gauge, half-inch needle. A 30-gauge needle is extremely fine, which significantly minimizes the pain of the injection itself. In fact, the discomfort is often just a small pinch. The half-inch length is ideal for this procedure because these target nerves are very superficial. It allows me to easily reach the target depth—just above the bone—without the risk of injecting too deeply into more sensitive or vital structures.

Executing the Injections: A Step-by-Step Guide

With the patient prepared and the equipment ready, I began the injection process. My technique is methodical and prioritizes safety and patient comfort at every step.

Injections 1 & 2: The Supratrochlear and Supraorbital Nerves

These first two injections are the most delicate due to their proximity to the eye.

1. Patient and Physician Positioning: I position myself to get a clear, stable view of the injection sites. The patient is comfortably reclined.
2. Protecting the Orbit: A crucial safety measure for these two injections is to prevent the anesthetic from diffusing downward into the orbit (the eye socket). To do this, I placed my non-injecting thumb firmly against the patient’s superior orbital rim, just below the injection site. This creates a physical barrier, or a bolster, directing the fluid to spread superiorly and laterally into the forehead tissues where the nerves travel, rather than into the delicate tissues surrounding the eye.
3. The Injection Technique:

• • I gently inserted the 30-gauge needle at the marked supratrochlear nerve site.
  • I advanced the needle until I felt the tip make gentle contact with the underlying bone (the frontal bone). This technique, known as “touching bone,” provides a reliable depth landmark, ensuring I am at the correct tissue plane—the supraperiosteal layer—where the nerve exits its foramen.
  • I then withdrew the needle just slightly (1-2 millimeters) so the tip was no longer against the bone but remained in the immediate vicinity.
  • Aspiration: Before injecting any fluid, I gently pulled back on the syringe plunger. This is called aspiration. I checked whether any blood entered the syringe. This critical safety step ensures the needle tip is not inside a blood vessel. Injecting anesthetic directly into an artery or vein can lead to systemic toxicity. Seeing no blood (“negative aspiration”), I proceeded.
  • I slowly and steadily injected the 1 mL of the anesthetic mixture. As I injected, I felt the fluid pressure building under my thumb, confirming that my bolster was effectively preventing backflow into the orbit.

• Repeating for the Supraorbital Nerve: I followed the same procedure for the supraorbital nerve at the second marked site, again using my thumb as a protective barrier and carefully aspirating before injecting. The patient tolerated these first two injections well, reporting only a minor pinch.

Injections 3 & 4: The Zygomaticotemporal and Auriculotemporal Nerves

These next two injections are farther from the eye, but they have their own unique anatomical considerations.

1. The Zygomaticotemporal Nerve Injection:

• • I moved to the third site, located over the zygomatic bone in the temporal area.
  • I again used the “touching bone” technique, advancing the needle until it contacted the zygoma.
  • I withdrew slightly and aspirated. Here, it is especially important to ensure the needle is not in a branch of the temporal artery. Aspiration confirmed we were clear of any vessels.
  • I injected the 1 mL of anesthetic. For this location, a thumb bolster is not necessary as there is no risk of fluid tracking into the orbit.

• The Auriculotemporal Nerve Injection:

• • Finally, I addressed the fourth site, just anterior to the ear. This area is anatomically rich, containing the superficial temporal artery and the TMJ.
  • I inserted the needle, again advancing until it touched the bone of the temporal fossa.
  • Critical Aspiration: Aspiration is essential here. The superficial temporal artery runs in very close proximity to the auriculotemporal nerve. Avoid intravascular injection here. After confirming a negative aspiration, I carefully injected the final 1 mL of anesthetic.
  • The entire injection process for all four nerves took only a few minutes.

I asked the patient about her experience. “Was that painful?” I inquired. “No, no,” she replied. “It felt pretty good. It was a little pinch on a couple of them.” She added, “Not as bad as we feared.” This immediate feedback is important; minimizing procedural pain helps build patient trust and reduces the anxiety associated with treatment.

Part 3: Immediate Assessment and the Path Forward

Assessing the Immediate Effects of the Nerve Blocks

With the injections complete, the most important question was: did it work? The lidocaine in our mixture acts quickly so that we could perform an initial assessment almost immediately.

• Subjective Pain Rating: Before the procedure, the patient had rated her headache a 7 out of 10. Just a few moments after the final injection, I asked her to rate her pain again. “I think it’s better,” she said thoughtfully. “More like a five.” This immediate two-point drop on the pain scale, even before the bupivacaine had fully kicked in, was a very encouraging sign. It demonstrated that we had targeted at least some of the correct pain-generating structures.
• Objective Palpation Test: To get more objective data, I went back and re-palpated the four injection sites with the same pressure I used during the initial examination.

• • “Does that hurt?” I asked, pressing over the supratrochlear nerve. “No,” she said. I clarified, “Did it hurt before?”Yes. Yes, it did.”
  • I moved to the supraorbital nerve. “Does it hurt when I press over here?”No.” “And did it hurt there before?” “Yes.”
  • I tested the zygomaticotemporal nerve. “And does it hurt over that area there?”No.”
  • Finally, I palpated the auriculotemporal nerve. “Does that hurt there?” “No.”

This was a resounding success. The exquisite tenderness at all four nerve exit points had been completely abolished. This confirmed two things: first, that the local anesthetic was working effectively, and second, that our initial diagnosis localizing the pain to these four nerves was correct. We had successfully numbed the peripheral triggers.

The Short-Term and Long-Term Prognosis

This initial success is just the beginning of the therapeutic process. Here is what we expect to happen next:

• The Next 30-60 Minutes: Over the next hour, the longer-acting bupivacaine will reach its peak effect. We expect her headache to continue improving, hopefully decreasing to a zero or near-zero level of pain. This period of complete relief is what we are aiming for to “break” the headache cycle.
• The Next Few Hours: The anesthetic block will provide several hours of significant pain relief. This respite is not just about comfort; it is a therapeutic window. It allows the overstimulated nerves and the central nervous system to calm down. The constant barrage of pain signals is interrupted, giving the neurological system a chance to “reset.”
• The Following Days and Weeks: The hope is that the pain relief will last beyond the anesthetic’s chemical effect. By interrupting the self-perpetuating cycle of pain and central sensitization, a single set of blocks can sometimes result in days, weeks, or even permanent relief from a specific headache episode. If the headache does return, it is often at a much lower intensity. The procedure can be repeated as needed, and for many patients, a series of blocks can provide long-term management.

“This looks good,” I told the patient. “Now we’ll just have to see over the next thirty to sixty minutes how much of an effect you got from these injections here. And hopefully, it’ll continue to work for hours afterward, and hopefully break this headache completely.”

Part 4: Integrating Nerve Blocks with Chiropractic and Functional Medicine

The nerve block procedure I performed is a highly effective tool for acute pain management, but at our clinic, it is never a standalone treatment. It is one component of a much broader, more holistic strategy designed to address the root causes of the patient’s condition. This is where integrating chiropractic care and functional medicine becomes essential to achieving lasting results.

The Role of Integrative Chiropractic Care

As a Doctor of Chiropractic, my primary focus is the body’s structural and neurological integrity, particularly the spine and its relationship with the nervous system. Headaches, even those with peripheral triggers in the face and scalp, are often profoundly influenced by dysfunction in the cervical spine (the neck).

• Cervicogenic Contributions: The upper cervical spine (C1, C2, C3) shares a critical neurological connection with the trigeminal nerve system. This is known as the trigeminocervical nucleus, a region in the brainstem where sensory nerve fibers from the face (trigeminal nerve) and the upper neck (cervical spinal nerves) converge. Because these signals meet and intermingle, the brain can have difficulty distinguishing the pain’s origin. This phenomenon, called referred pain, means that irritation or dysfunction in the joints, muscles, and ligaments of the upper neck can be perceived as a headache. (Bogduk, 2003).
• Chiropractic Assessment and Treatment: Following the acute relief provided by the nerve blocks, my approach with this patient would include:

• Detailed Spinal Examination: I would assess cervical alignment and movement. I would look for subluxations—subtle misalignments that can irritate surrounding nerves and create muscle tension.
• Chiropractic Adjustments: Gentle, specific chiropractic adjustments restore proper motion to the spinal joints. By correcting subluxations in the upper cervical spine, we can reduce nerve irritation at the source, decrease strain on the brainstem, and alleviate the “cervicogenic” component of the headache. This can fundamentally reduce the background tension that makes the peripheral nerves in the face more susceptible to irritation.
• Soft Tissue and Myofascial Release: The muscles of the neck and upper back—such as the trapezius, sternocleidomastoid, and suboccipital muscles—are often chronically tight in headache sufferers. This tension can directly compress nerves and contribute to poor posture, which further strains the cervical spine. I utilize techniques like myofascial release, trigger point therapy, and instrument-assisted soft tissue mobilization to release this tension, improve blood flow, and restore normal muscle function. This directly complements nerve blocks by addressing the muscular compression that may have irritated the nerves in the first place.

The Functional Medicine Perspective: Looking Deeper

Functional medicine seeks to identify and address the underlying metabolic, nutritional, and lifestyle factors that contribute to chronic disease and pain. A headache is not just a structural or neurological problem; it often signals a deeper systemic imbalance.

• Identifying Inflammatory Triggers: Chronic inflammation drives chronic pain. In a functional medicine workup, we might investigate potential sources of inflammation, including:

• Dietary Triggers: Food sensitivities (to gluten, dairy, etc.), high sugar intake, and consumption of processed foods can all promote a pro-inflammatory state in the body. An anti-inflammatory diet can be a powerful therapeutic tool.
• Nutrient Deficiencies: Deficiencies in nutrients like magnesium, B vitamins (especially B2 and B12), and Coenzyme Q10 have been linked to an increased frequency and severity of headaches and migraines. (Schürks et al., 2008).
• Hormonal Imbalances: Fluctuations in hormones like estrogen and cortisol can trigger headaches.
• Gut Health: The gut microbiome profoundly affects systemic inflammation. A condition known as “leaky gut” (increased intestinal permeability) can allow inflammatory molecules to enter the bloodstream, contributing to pain conditions throughout the body.

• Personalized Protocols: Based on a comprehensive assessment, which may include advanced laboratory testing (such as organic acids tests, food sensitivity panels, or comprehensive stool analysis), we can create a personalized protocol for the patient. This might include targeted nutritional supplements, specific dietary modifications, stress-management techniques (since stress is a major trigger for muscle tension and inflammation), and strategies to improve sleep quality.

A Truly Integrated Treatment Plan

By weaving these different modalities together, we create a synergistic and comprehensive treatment plan for our patient with Hemicrania Continua:

1. Acute Phase (Immediate Relief): Perform targeted peripheral nerve blocks to break the acute pain cycle and confirm the diagnosis. This is done under the medical direction of Dr. Cardenas.
2. Structural Phase (Restoring Alignment): Provide chiropractic care to address underlying cervical spine dysfunction and reduce neurological interference at the trigeminocervical nucleus. Use myofascial techniques to release tension in the head, neck, and shoulder muscles that may compress peripheral nerves.
3. Functional Phase (Addressing Root Causes): Utilize a functional medicine approach to identify and mitigate systemic drivers of pain, such as inflammation, nutrient deficiencies, and metabolic imbalances.
4. Rehabilitation and Empowerment: Provide the patient with education on posture, ergonomics, and specific therapeutic exercises to maintain spinal health and prevent recurrence. Empower her with lifestyle and dietary strategies to manage her health proactively.

This multifaceted approach ensures that we are not just chasing symptoms. We provide immediate relief while correcting the underlying structural and metabolic issues that led to the pain in the first place. This commitment to comprehensive, integrated care defines our practice at Injury Medical Clinic and offers our patients the best possible path to long-term health and wellness.

Thank you for joining me on this clinical journey.

References

• Bogduk, N. (2003). The anatomical basis for cervicogenic headache. Journal of Manipulative and Physiological Therapeutics, 17(3), 183-187. This seminal work is not directly hyperlinked as a full journal article title. However, the conceptual reference points to foundational literature connecting neck anatomy to headache pathology.
• Janis, J. E., Hatef, D. A., Ducic, I., Ahmad, J., Wong, C., & Cheesborough, J. E. (2010). The anatomy of the greater occipital nerve: Part II. The course of the nerve in the suboccipital region. Plastic and Reconstructive Surgery, 126(5), 1563-1572. [https://journals.lww.com/plasreconsurg/Abstract/2010/11000/The_Anatomy_of_the_Greater_Occipital_Nerve__Part.24.aspx](https://journals.lww.com/plasreconsurg/Abstract/2010/11000/The_Anatomy_of_the_Greater_Occipital_Nerve__Part.24.aspx)
• Schürks, M., Diener, H. C., Goadsby, P. J., & Reuter, U. (2008). Update on the prophylaxis of migraine. Current Treatment Options in Neurology, 10(1), 20-29. This is another conceptual citation where specific journal titles are not hyperlinked but point to the body of research on migraine prophylaxis.
• Woolf, C. J. (2011). Central sensitization: Implications for the diagnosis and treatment of pain. Pain, 152(3 Suppl), S2–S15. [https://www.painjournalonline.com/article/S0304-3959(10)00829-3/fulltext](https://www.painjournalonline.com/article/S0304-3959(10)00829-3/fulltext)

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