Clinic-based Procedures for Headache.

PURPOSE OF REVIEW: Headache disorders are common and disabling, and many therapies that are effective and safe are procedural.

RECENT FINDINGS: After pivotal clinical trials, onabotulinumtoxinA has become an established preventive therapy for chronic migraine; it is better tolerated than many other treatments and may be useful for other headache disorders. Peripheral nerve blocks, especially greater occipital nerve blocks, have amassed evidence from randomized trials in the acute and short-term preventive treatment of migraine and cluster headache. Trigger point injections and sphenopalatine ganglion blocks have recent trials suggesting efficacy and safety in properly selected patients. Medical education initiatives are needed to train neurologists in these procedures to help manage the large population of patients with headache disorders who need them.

SUMMARY: Evidence exists for the efficacy and safety of procedural therapies to be incorporated into neurology practice for the management of patients with migraine, cluster headache, and other headache disorders.