Peripheral Nerve Blocks in the Treatment of Pediatric Headache and Neuralgia: A Scoping Review.

INTRODUCTION

Pericranial peripheral nerve blocks are widely used in pediatric headache practice by subspecialty clinicians, but the published studies vary in technique, indications, and outcome reporting. The objective of this scoping review was to describe the existing evidence of pericranial peripheral nerve blocks for children and adolescents with primary and secondary headache disorders or cranial neuralgias.

METHODS

A systematic search was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. Searches were conducted in February 2025 and updated in February 2026. Study design, populations, indications, outcomes, and adverse events were summarized descriptively. No critical appraisal or meta-analysis was performed.

RESULTS

The search identified 1503 records; after duplicate removal, full-text review, and bibliography searching, 39 studies were included (29 peer-reviewed articles and 10 abstracts) published between 1997 and 2025. The greater occipital nerve was the most frequently targeted. Chronic migraine and mixed primary headache were the most common indications. Lidocaine and bupivacaine were the most used anesthetics with steroids included in one-third of studies. Reported adverse events were typically mild and transient. No study reported serious procedure-related adverse events.

CONCLUSIONS

Pediatric studies on pericranial nerve blocks for head pain span nearly three decades and consistently describe these procedures as safe and clinically helpful. However, literature is dominated by observational studies and case series, with few randomized controlled trials and variability in procedural techniques. Future collaborative pediatric research using standardized methodologies will help strengthen the evidence base and shape best practices for the care of head pain in youth.