Pain Management Procedures
Facial & Scalp Nerve Blocks
Facial and Scalp Nerve Blocks
What are they?
Small sensory nerves carry feeling from specific areas of the face and scalp. A targeted nerve block places a small amount of local anesthetic, sometimes with another medication, near one of these nerves. APG's list includes supraorbital, infraorbital, trigeminal-branch, scalp, and mental nerve blocks.
Which area does each block cover?
· Supraorbital nerve: forehead, upper eyelid, and front portion of the scalp. It may be considered for supraorbital neuralgia and selected headache disorders.
· Infraorbital nerve: lower eyelid, side of the nose, upper lip, and part of the upper cheek. It may be used for localized midface pain or selected trigeminal pain.
· Trigeminal nerve or branch: targets one division of the main sensory nerve of the face for sharp, electric facial pain after a diagnosis such as trigeminal neuralgia has been evaluated.
· Scalp nerve block: a group of superficial nerves may be blocked for pain after head trauma or cranial surgery. The exact nerves must be named in the treatment plan; “skull nerve block” is not one standardized procedure.
· Mental nerve: supplies the chin and lower lip. It can help diagnose or treat pain in that distribution, but it does not numb the lower teeth by itself.
What happens?
The skin or inner mouth is cleaned, depending on the target. The clinician uses landmarks and sometimes ultrasound to place a fine needle beside the nerve. Only a small volume of medication is usually needed. Temporary numbness in the expected area helps show that the correct nerve was reached.
What should I expect?
Numbness often begins within minutes and lasts for hours. Therapeutic relief may last longer, but response varies. Avoid biting or burning numb lips or cheeks until normal sensation returns.
Important risks
Bruising, swelling, temporary altered sensation, bleeding, infection, and medication reaction are possible. Blocks near the eye have uncommon but important orbital and vision-related risks. Trigeminal procedures can have additional risks depending on how close to the skull base the target is. New facial weakness, vision change, severe eye pain, or trouble speaking requires urgent evaluation.
Preparing for your injection procedure…
Your instructions will depend on the procedure. Before any injection, tell the APG team if you:
Take aspirin, warfarin, clopidogrel, apixaban, rivaroxaban, or another medicine or supplement that affects bleeding. Never stop a prescribed blood thinner unless the clinician who manages it and the procedure team tell you how to do so safely.
Have diabetes, glaucoma, a bleeding disorder, an active infection, fever, or recent antibiotic treatment.
Could be pregnant, have an allergy to contrast dye or local anesthetic, or have reacted to steroid injections before.
Use an implanted pacemaker, defibrillator, spinal cord stimulator, or other electrical device.
Some procedures require fasting, a medication adjustment, or a responsible adult to drive you home, especially when sedation is planned. Follow the instructions provided for your specific appointment.
After your injection procedure…
Most injections are outpatient procedures. Mild soreness, bruising, temporary numbness, or a brief increase in the usual pain can occur. Follow the activity and bandage instructions you receive. Steroid medicine may take several days to have an effect and can temporarily raise blood sugar.
Call the office promptly for increasing redness, drainage, fever, severe or rapidly worsening pain, or new numbness or weakness. Seek emergency care for trouble breathing, chest pain, sudden loss of bladder or bowel control, a severe new headache, loss of vision, stroke-like symptoms, or rapidly progressing weakness.
This information is for general education and does not replace medical advice, diagnosis, or treatment. Not every procedure is appropriate for every patient, and results vary. Your APG care team will review your symptoms, examination, imaging, medical history, medications, and prior treatment before recommending a plan. Coverage requirements also vary by insurance plan.