Migraine Management in the Post-COVID-19 Era: A Neural Block-Oriented Approach

PROGRAM DESCRIPTION: Migraine is a common illness often masquerading as other conditions such as sinus, balance, or ear complaints. As such, these patients often seek otolaryngologists for evaluation. In the post-Covid-19 era, the incidence of migraine-related illness has increased significantly, and migraine manifestations explain many of the symptoms seen in patients suffering with "Long Covid," or PASC (Post-acute sequelae of SARS-CoV-2 infection). The pathophysiology involved will be discussed to help improve understanding of why this is occurring. What is difficult is that many of these patients lack headache as the primary symptom and present with other complaints not typically thought of as migraine-related or that mimic other conditions. Therefore, proving the diagnosis is often the challenge. Sphenopalatine blocks have been used in this regard by some migraine specialists when the diagnosis is unclear. Unfortunately, these procedures are often obtained late in the process, because 3rd-party-payors often deny reimbursement until after failure of 3 medications. As a result, patients often do without. As otolaryngologists, we can bypass expensive catheter devices by using nasal endoscopy and inexpensive materials we use routinely such as cotton and topical lidocaine. Because nasal endoscopy requires no pre-certification, we can offer these procedures as part of our office evaluation and remove this barrier. As nasal surgeons, we can perform blocks accurately and include the anterior ethmoid nerve. With optimal comfort and minimal patient risk, intranasal blocks, coupled with occipital nerve blocks, can be used to diagnose and fully arrest migraines in 10 minutes and prevent them for months. As such, blocks have become a game-changer in our clinic.

Data will be shared from a pilot study which demonstrates the efficacy of blocks - both acutely and long-term. Also, the patients’ "primary complaint" data will be presented to help providers recognize which patients to suspect have migraine-related symptoms. Finally, management strategies for these patients, once diagnosed, will be discussed.