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Do Pediatric Headaches Respond to Bilateral Lower Cervical Paraspinous Bupivacaine Injections?

Mellick, Larry B. MS, MD, FAAP, FACEP*; Pleasant, Michelle R. MD

doi: 10.1097/PEC.0b013e3181d1e162
Original Articles

Objective: Bilateral lower cervical paraspinous intramuscular bupivacaine injections have recently been reported as a therapeutic modality for headache pain in adult patients presenting to an emergency department. In this study, we accomplished a retrospective review of all pediatric patients with headaches who were treated with this technique in an emergency department setting over a 16-month period. The therapeutic response of all pediatric patients who received bilateral lower cervical paraspinous intramuscular bupivacaine injections for headache pain is described in this article.

Methods: Three separate databases were reviewed to capture all patients younger than 18 years with a diagnosis of headache who received bilateral cervical injections between June 30, 2003, and December 1, 2004, in the Medical College of Georgia and Children's Medical Center emergency departments. Their medical records were retrospectively reviewed to determine their response to this procedure.

Results: The headaches of 13 patients younger than 18 years were treated with this procedure. The mean headache severity was 9.15, and the mean duration of headache was 3.16 days. Six (46.2%) of 13 patients had complete relief of their headaches, whereas 5 (38.4%) of 13 patients had partial relief. No significant relief was documented in 2 (15.4%) of 13 patients. A therapeutic response was documented in 11 (84.6%) of 13 of the patients.

Conclusions: These retrospective observations suggest that bilateral lower cervical paraspinous intramuscular injections with small amounts of bupivacaine may have a therapeutic role in the management of headache pain in children, and their rate of therapeutic response may be similar to that recently reported for adult headache patients.

From the *Professor of Emergency Medicine and Pediatrics, Medical College of Georgia, Augusta, GA; and †Physicians Regional Medical Center, Naples, FL.

Larry B. Mellick, MS, MD, FAAP, FACEP, Department of Emergency Medicine, Medical College of Georgia, 1120 15th St, AF-2039, Augusta, GA 30912 (e-mail:

© 2010 Lippincott Williams & Wilkins, Inc.