Hemiplegic Migraine and Paraspinous Cervical Injections with Bupivacaine

​I recently treated a patient with hemiplegic migraines successfully with bupivacaine cervical injections, a novel therapeutic technique using paraspinous cervical injections. The technique employs deep intramuscular injections of 1.5 mL of 0.5% bupivacaine bilaterally into the paraspinous muscles of the lower neck. (Read more in my October 2012 blog and see it demonstrated in a video at http://bit.ly/2ewC5n1.)This headache and orofacial pain treatment was first described in 1996 by my twin brother, Gary Mellick, DO, a neurologist who did a pain fellowship. The exact mechanism is unknown, but the treatment appears to work centrally on the brain based on convincing observations. Evidence of central effects include resolution of cortical-related signs and symptoms such as nausea, photophobia, and allodynia. The first three cervical nerves that innervated the neck and scalp travel directly into the brain stem and the trigeminal caudate nucleus, a relay center important to other successful headache medications. This relay center in the brain stem also has synapses with cranial nerves 5, 7, 9, and 10 and antinociceptive centers such as the periaqueductal gray, nucleus raphe magnus, and the rostroventral medulla synapse, which have a profound antinociceptive effect. Neural connections to the cerebral cortex are also documented.Until now, no actual physical evidence has documented central activity other than patient-reported relief of headache and nausea, photophobia, phonophobia,...
Source: M2E Too! Mellick's Multimedia EduBlog - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Related Links:

In this study, the obtained IC50 concentration of 51.25 μg/mL exhibits significant anticancer activity against A549 cells than other tested concentrations because of the release of zinc ions, which induce the cell apoptosis. Furthermore, studies on cell cycle validate that ZnO NPs arrest the cell cycle at the sub-G1 phase of A549 cells. These results suggest the utility of phytogenic ZnO NPs for various biomedical applications.Graphical abstract
Source: Biocatalysis and Agricultural Biotechnology - Category: Biotechnology Source Type: research
This article is licensed under aCreative Commons Attribution-NonCommercial 3.0 Unported Licence.Da-Jiang Liu, Peter Michael Spurgeon, Jiyoung Lee, Theresa L Windus, Patricia Ann Thiel, James W. Evans Experimental data from low-temperature Scanning Tunneling Microscopy (LTSTM) studies on coinage metal surfaces with very low coverages of S is providing new insights into metal-S interactions. A previous LTSTM study... The content of this RSS Feed (c) The Royal Society of Chemistry
Source: RSC - Phys. Chem. Chem. Phys. latest articles - Category: Chemistry Authors: Source Type: research
CONCLUSION: Our analysis found that patients had excellent outcomes across multiple PROM metrics. Future work can build on these results with large patient populations over longer follow-up intervals. Nevertheless, these results provide the foundation and evidence to support the continued use of this innovative technology for total knee arthroplasties. PMID: 31732961 [PubMed - as supplied by publisher]
Source: Surgical Technology International - Category: Surgery Tags: Surg Technol Int Source Type: research
Authors: Wang J, Chen Z Abstract Pain is a salient and complex sensory experience with important affective and cognitive dimensions. The current definition of pain relies on subjective reports in both humans and experimental animals. Such definition lacks basic mechanistic insights and can lead to a high degree of variability. Research on biomarkers for pain has previously focused on genetic analysis. However, recent advances in human neuroimaging and research in animal models have begun to show the promise of a circuit-based neural signature for pain. At the treatment level, pharmacological therapy for pain remain...
Source: Advances in Experimental Medicine and Biology - Category: Research Tags: Adv Exp Med Biol Source Type: research
Authors: Girard BC, Lévy P Abstract PURPOSE: To determine the significance of dry eye syndrome in benign essential blepharospasm. DESIGN: Retrospective consecutive case series. PARTICIPANTS: One hundred and forty-four patients (288 eyes) with benign essential blepharospasm. METHODS: All subjects had Schirmer I tear tests. Those scores were analysed as a function of patient age, sex, and blepharospasm severity. MAIN OUTCOME MEASURES: Individual Schirmer-test scores in both eyes of all patients. RESULTS: A total of 144 eligible subjects (mean age±SD: 68.3±11.5 years; 76% femal...
Source: Journal Francais d Ophtalmologie - Category: Opthalmology Tags: J Fr Ophtalmol Source Type: research
CONCLUSION: Optic neuritis is a pathology frequently encountered in ophthalmology; a good knowledge of symptoms and clinical signs is essential for early diagnosis and optimal management. The identification of autoantibodies, including anti-MOG antibodies, is important for patient management and is part of the required testing for all cases of optic neuritis, in order to adapt the treatment of the acute episode and to provide maintenance therapy to avoid recurrence. PMID: 31732265 [PubMed - as supplied by publisher]
Source: Journal Francais d Ophtalmologie - Category: Opthalmology Tags: J Fr Ophtalmol Source Type: research
CONCLUSIONThe perforated gastric ulcer is a complication of the mini bariatric bypasses, and the laparoscopic treatment of the perforation associated with thorough irrigation for of the abdominal cavity and omentoplasty present good results for management of this complication.
Source: Annals of Medicine and Surgery - Category: General Medicine Source Type: research
AbstractSevere pelvic fractures often prove difficult for surgeons as they require patient-specific surgical treatment plans and customized equipment. Developing virtual patient-specific 3D pelvis models would ease the surgical planning process and enable development of custom fixation plates. This paper aims to examine pelvic symmetry to conclude whether the contralateral side may be used as a reference model for the fractured side of the pelvis. Fourteen subjects with intact pelvises were involved in this study. CT scans of the pelvises were converted to 3D models and the right sides of the pelvises were reflected and al...
Source: Medical and Biological Engineering and Computing - Category: Biomedical Engineering Source Type: research
esheng Wang A diatomite supported graphene oxide composite (GO@Dt–NH2) was fabricated and explored as a solid-phase extraction adsorbent coupled with high performance liquid chromatography to determine the trace hydroxyl polycyclic aromatic hydrocarbons (2-hydroxy-naphthalene, 2-hydroxy-fluorene, 1-hydroxy-phenanthrene, and 1-hydroxy-pyrene) in urine samples. The fabricated composites were characterized by X-ray powder diffractometry and scanning electron microscopy. GO@Dt–NH2 offered enhanced adsorption affinity towards the analytes compared with the bare diatomite. The amount of graphene oxide and...
Source: Molecules - Category: Chemistry Authors: Tags: Article Source Type: research
CONCLUSION: This is the first evaluation of regret after hysterectomy specifically examining a younger patient population. The study results suggest that patients who are appropriately counselled do not regret their decision to proceed with hysterectomy. PMID: 31734156 [PubMed - as supplied by publisher]
Source: Journal of Obstetrics and Gynaecology Canada : JOGC - Category: OBGYN Tags: J Obstet Gynaecol Can Source Type: research
More News: Aphasia | Blogging | Brain | CT Scan | Emergency Medicine | Genetics | Headache | Health Management | Laboratory Medicine | Lumbar Puncture | Men | Migraine | Neurology | Pain | Pediatrics | PET Scan | Respiratory Medicine | Study | Tinnitus | Toxicology | Vertigo