oh my gosh he announced but it's like
it's like gone Rebecca who some of you
remember from an earwax cleaning video
has been having headaches and does have
migraine and this particular headache
you've been having now for the last
three weeks just a block 11 mostly on
little off maybe a couple hours of a
break daily but not even everyday right
and we're going to use a technique of
nerve block on the Greater and Lesser
occipital nerves where they come out in
the back of the skull right two and two
the purpose is to block those nerves
that serve sensation not only for the
outside of school but even on the inside
where you're actually feeling the pain
of the headache this will most often
totally break a migraine so I was taught
this technique at USC by dr. so much I
srivastava and forgive me so much I got
your name wrong but thank you so much
for teaching and so many of many of my
followers on YouTube they know when I
was there because I made a little or try
to make a little video on their their
internet connection was down there but
we're going to bring that teaching from
USC at their neurology conference to you
right now okay we're going to show how
we do it I do a little differently from
from soma and the way I'm doing it
differently is that i'm using
epinephrine with the lidocaine which I
know that from my procedural background
a little bit it helps to numb it longer
the epinephrine will limit blood flow to
and from the area so it doesn't get
filtered out and cleaned out it also
makes for Leslie me which everybody
likes now when we do these shots in
people it's right where your hair is so
we're not really doing a clean injection
but we're being very careful we go ahead
and we we do a couple things to make it
easier we rub the skin with an alcohol
wipes there's a little less bacteria on
it we don't shave hair off and we don't
need to because nobody
really against infections from this and
then she also sprays with a topical
anaesthetics pray that I'll put on it
that makes it a little bit easier when
you get the shot but we're he's not
really planning needles yeah you
remember that one so we'll get started
right away but so I'm going to push your
hair forward you okay there we go come
along come along oh so hair forward and
people may notice you have a little
coloration on your neck and that's
nothing abnormal that's what I gave lots
of yeah people people have coloration
there that's not part of what's going on
here so I'm going to be pushing and
possibly a little uncomfortably pushing
first I'm finding the prominence of the
occiput Knoxville prominence is kind of
in the mailbox yeah yeah yeahs there to
walk and then amputation sort of amusing
well I'm going to be going between that
and the upper part of the tragus is
right let me look here right here so if
you draw a line between those I'm going
to be going at the midpoint for the
greater occipital nerve and then halfway
between what's left for the lesser
occipital nerve so that means I'm going
to be pushing right about here until I
find the tender spot have I found the
tender spot yeah yeah yeah okay good so
yours yours is actually closer to this
and some people will say instead the
midpoint say do each of them they had a
third of the distance Oh so if their or
their walk a little ball all right let's
and again I just want to confirm that's
the tender spot huh all right so we'll
spray a little bit ethyl chloride to to
make it cold and then we'll give you a
shot aiming upward to the spot not
wanting to hit the skull drawing back to
make sure we're not in a blood vessel
and then going ahead and administering
I'm putting in two cc's of lidocaine
with epinephrine with 0.2 cc's of sodium
bicarbonate you don't ok ok well let
make sure you hadn't passed down well I
feel ya i'm going to fan it a little bit
where I pull out and go back in draw a
little bit more in that direction you
still awake yeah ok is it hurting yeah a
little bit i found that might be side
effects like right on ok so this is the
greater occipital nerve on the right and
then i'm going to push it in and massage
it in still okay with it off ok well i
don't want to find out that you passed
out by having my foot get warm all of a
sudden that's not the way you want to
fight that i haven't but one of the
instructors with dr. so he was talking
about that's how he found out that the
patient passed out was his foot got warm
yeah you don't want to do that yeah ok
and generally what they'll do is give
the patient a bit of a break between the
injections because the the closer you do
them together the more chance you're
going to cause stimulation that can lead
to them passing out I'm going to very
slowly go through this here and start to
locate the lesser occipital nerve and
start to clean the skin off with an
alcohol wipe but we're no rush here if
you want me to slow down I can so we're
going to find the prominence again
and you know two thirds of the way over
let me feel where the tragus is there so
I know we're in the right spot so most
likely it's in this area yeah yeah you
can push on it real tender spot I just
find out yeah it's right about there yes
it is yes it is that's what it feel like
this right there is that where you were
yeah a little bit yes rob was right
thing yeah we compare that again I'm
feeling the tragus feeling the
prominence on the occiput and yeah about
that would that would be it Wow let me
give it a little straight always long oh
yeah you'll feel it's all sorts of
directions yeah so this is getting a
little cold in that area to act as a
local topical anesthetic so we can give
you an injection in that same spot where
you said you felt it and I'm going to
start to inject the medicine that
probably stings as it goes in and
there's a reason I'm directing from low
to high on the patient's body and that
is to help to avoid accidental injection
into the spinal canal which if you're
doing the opposite direction there's a
small risk although with these small
needles it's less likely and we make
sure we're up on the skull not down
lower so I'm Fanning it out to get a
larger area to spread out the anesthetic
and then I'm going to rub that one in so
that's the lesser occipital nerve all
good okay so not too bad can you tell
any change in the headache pain I feel
alone in the life sciences what no okay
Wow so there's tragus with that finger
and I know that people in the video
can't even somebody in person here can't
see exactly what I'm touching because of
the hair but that's just the nature of
it so that's what that will put it right
no no well we can get what's called the
dorsal occipital nerve most people don't
have one and it exists right here if you
say yes writing your old guy well you
may have a dorsal occipital nerve that
we will go ahead we will give an
injection there also oh okay so what I'm
hitting is an area that's actually just
off to the side of mid line between the
occipital prominence and the tragus of
the ear on a line between them and yeah
some people that is their tender spot so
let me hit that on this one and maybe
we'll go back on the other one hit it
too
well of course you can get fit all over
yeah quite worth it yeah okay I'm gonna
hit it one more one more time as far as
my finger on it right about there yes
yeah some people that'll be the spot to
hit all right going to give you a shot
there draw panic make sure there's no
blood start to inject you said ooh
yeah close that's where it hurts wha and
we may have to do that also on the other
side no no there's variations from
person to person yeah a little bleeding
with that one so I'm going to push it in
yeah we want to want to work that in
how's the headache last bowl better on
one side or all over I would say just
over all over fields when you say this
kind of relief you mean like this is the
best it's felt in what two or three
weeks that's certainly gonna go all
right okay good good good so we're going
to we're going to journey over back to
the right side because you seem to
benefit from giving an injection where a
dorsal occipital nerve would be located
so let's see if you have tenderness same
size same nerve on the right side so
we've hit two on the right side which
actually for most people will be
complete not so for you well as long as
we know it and we can identify it and
make you feel better by taking into
account how you're different then that's
great still feeling okay
alright we're going to yeah so I find
the prominence again there it is and
then I go just lateral to it that is it
isn't it yep and the reason I know where
to go is just because of how far it is
you know just just a centimeter be less
than a centimeter over from you can see
some plastic there that's okay all right
can I drop and inject you feel it like
you did that last one off so you're
feeling it more than you did the the
other two yeah and how about going down
the back now is this causing a fastball
sensation there just less pain Wow well
we may not have to do anything more than
this we may not have to do a greater and
lesser on the left side if come on if
this works if this totally eliminates
the pain we don't have to so let's rub
that in and probably have you sit up for
a little bit after getting four of those
injections still have headache well it's
pretty much long and can you localize
where where you feel it if it is well
just get so much back here that I
thought well since you are plants that
are getting it back sure so that means
your neck that's right your Twitter
please figure out what to do go ahead
and let raise your head up and sit up
for a moment how's that feel fine
actually Wow can you can you sort of
point to a region or area that still
hurts well
we thought you blocked a lot it's all
gone I have I have not felt this good in
three weeks I am serious this is this is
great and it isn't bad I I didn't know
what to expect thank you so much for
letting us do this thank you and thank
you for joining us I do need to if you
just allow me to thank some people who
helped make this possible that they
decided that would be like booboo Kitty
and Lindsey antwine our new patron Petra
from Sweden we thank you all for helping
make this possible you also can become a
part of that by looking at the auburn
medical patreon will be a link to that
and you can make sure you're subscribed
to this this channel if you like these
type of medical videos and seeing
patients who enjoyed helping you learn
about medicine like like Rebecca here
until next time Dr Marlin and Rebecca
following all of you to stay in good
health thanks