Case: 56-year-old male patient. He has had a headache for 5 years and epileptic seizures have been added to this headache for the last 3 years. For this, our patient applied to various clinics. No image could be found to explain the cause of epilepsy in the non-contract cranial MR taken in these areas. This HSV encephalitis did not respond to medical treatment and continued with headaches and seizures. Carbamazepine was started for the treatment of epileptic seizures, but the seizures did not change, the headache continued, and the findings of HSV encephalitis continued in the control contrast-enhanced cranial MRI taken at 6-month intervals. Thereupon, our patient applied to our clinic because of headache. VAS was 8-9. When our patient came, we decided to perform a direct interventional block because the headache did not respond to medical treatments and was severe. First, bilateral greater lesser occipital
block was performed. The VAS immediately dropped to 6-7. Our patient was called for control after 21 days to continue the same carbamazepine treatment.
VAS in control was 5-6. His seizures decreased, but he still had occasional seizures. Thereupon, supraorbital infraorbital trochlear nerve block was added to our patient next to the Graeter lesser occipital block, and he was called for control again 21 days later, continuing the carbamazepine treatment. In the control, his VAS was 3-4 and his seizures were considerably reduced. Thereupon, both of the interventional blocks were repeated exactly and the treatment continued and he was told to come for the control after 21 days. The VAS at control was 0-1. He had never had seizures. Here, both of the interventional blocks were repeated exactly and the treatment was continued and after 21 days, cranial MRI with contrast was requested and he was asked to come for control. In the control, our patient had a VAS of 0, had no seizures, and no pathology was found in the contrast-enhanced cranial MRI, and the result was normal.
Thereupon, we discharged our patient 6 months later to come for control without any procedure.
Conclusion: We think that interventional blocks have an important place in the treatment of resistant headache and that other units should refer patients to the algology outpatient clinic for this interventional block for the treatment of such refractory headaches. Again in these interventional blocks, we think that the pathology in the brain is corrected because there is parasympathetic activity in which sympathetic block is made, and there is vasodilation associated with this and it causes an increase in oxygen in the damaged area.
